Alternative therapies for weight control
Obesity and its related medical conditions are linked to higher healthcare costs and greater use of conventional medical treatment.¹ Emerging research suggests that some complementary and alternative medicine (CAM) therapies may help manage obesity-related conditions. Yet, the use of CAM for weight loss is relatively low, and when it is used, it is often with other weight-loss strategies.² One problem that makes a review of CAM therapies for weight loss difficult is the great variety of techniques and methods in use. For example, there are many different kinds of yoga, and in acupuncture, there are differences in needle selection and placement. Without rigorously-controlled practice standards for yoga and acupuncture, it is challenging to compare CAM therapies to more conventional approaches for weight loss.
It might seem that people with obesity would use CAM therapies to help cut down on healthcare costs. However, researchers analyzed national survey data on CAM use in over 31,000 adults and found that adults with higher BMIs (body mass index, a measure of body fat) were no more likely to use CAM therapies, such as relaxation techniques, massage, yoga, acupuncture, tai chi, or chiropractic, than normal weight adults.¹ Obese adults did not use yoga as much as adults with lower BMIs, possibly because of difficulty or embarrassment doing the activity.
A review of published research on yoga and acupuncture for weight control follows:
Yoga and Weight Control
Yoga is a mind-body practice that people use to improve relaxation, fitness and health. Research suggests that through its combination of physical postures, breathing techniques and meditation, yoga may help with a variety of health conditions such as anxiety, stress, depression and high blood pressure.³
Limited research suggests that regular yoga practice may also help promote weight loss and slow down weight gain, particularly in overweight adults. In 2005, researchers analyzed survey data on 15,500 healthy, middle-aged adults and found that over a 10-year period, overweight people who practiced yoga for four or more years lost 5 pounds, while overweight people who did not practice yoga during the same period of time gained 14 pounds.⁴ Although many people were surveyed, these were self-reported data and the study design was retrospective, meaning it looked to the past. Carefully controlled prospective studies, which follow people forward in time, are needed to evaluate CAM therapies more rigorously. Nonetheless, the data suggest that yoga may help slow weight gain because it increases mindfulness and, therefore, mindful eating. People who eat mindfully are more aware of the reasons they eat and their feelings of hunger or fullness. Since yoga helps reduce stress and anxiety, it may also decrease eating triggered by these emotions.
To test whether yoga had an effect on people’s eating habits, researchers needed a tool to measure mindful eating. So Alan Kristal, DrPH, and colleagues developed and validated a Mindful Eating questionnaire.⁵ The questionnaire addressed eating even when full; being aware of how food looks, tastes or smells; using food in response to emotional stress; being influenced to eat by environmental cues; and eating while distracted.
Using the Mindful Eating questionnaire, the researchers found that yoga practice, but not walking or other physical activities, was strongly associated with mindful eating.⁵ Those individuals with higher scores on the questionnaire also had lower BMIs. Researchers suggested that since yoga encourages individuals to hold a challenging physical pose with an "accepting, calm mind and focus on the breath," these mindfulness skills may help people stay in better control in challenging food environments and more accurately judge their reasons for eating.
Further research is needed on the impact of yoga on mindful eating, as well as other factors that alter energy balance. For example, does yoga enhance a person’s motivation or confidence to adhere to other forms of exercise or health-related behaviors? Do different types of yoga practice affect weight management and can yoga improve specific obesity-related health conditions such as high blood pressure, diabetes or heart disease?
Although existing data appear promising, it remains unclear whether adding yoga to a weight loss program that includes limiting calories and portions, eating nutritiously and being physically active will make losing weight and maintaining weight loss more likely.
Acupuncture and Weight Control
Acupuncture is a complementary and alternative medicine (CAM) therapy that involves inserting needles into specific points on the body to improve or maintain health. In traditional Chinese medicine, it is believed that acupuncture restores the balance and flow of vital energy called Qi, which helps maintain health.⁶ Although acupuncture is used in CAM to reduce body weight, how it might do this or if it, indeed, does promote weight loss is uncertain.
Studies from the 1990s showed mixed results. One Australian study of 60 people found that frequent stimulation of auricular (ear) acupuncture points helped suppress appetite, while an Italian pilot study of 40 obese people found that acupuncture improved anxiety and depression but did not promote weight loss.⁷,⁸
A 2009 review of randomized controlled trials (RCTs), the gold standard of clinical research, was performed to assess whether any form of acupuncture reduced body weight or improved obesity outcomes.⁹ Nineteen databases, including English, Korean, Chinese, and Japanese databases, were searched. Thirty one studies, with a total of 3013 participants, met the researchers’ criteria for inclusion in the review.
Researchers found that acupuncture appeared to be beneficial in reducing body weight and improving obesity. However, many of the studies were of poor quality, which prevented the researchers from drawing a definite conclusion on whether acupuncture is effective for treating obesity.
More specifically, 20 of the 31 studies reviewed had the lowest score on the Jadad scale, a widely used scoring system that measures the quality of a study. Problems included unclear or missing information on the randomization process, statistical analyses, acupuncture procedure, and dropout rates of the studies. Nonetheless, the data showed that acupuncture reduced body weight by about 3.5 pounds on average compared to placebo or sham treatments. Other data comparing acupuncture to drug treatment showed a 4-pound greater improvement in weight loss with acupuncture as compared to the use of conventional medication (sibutramine) for obesity. However, in general, these findings need to be treated with caution because of the low quality of the studies.
Researchers concluded that since acupuncture is a generally safe treatment, obese patients who want to try it should not be discouraged, if they can afford to pay for it out of pocket. Given the current state of the science, insurers are unlikely to reimburse for it as a weight loss treatment. Long-term, well-designed clinical trials, with details of acupuncture procedures, are needed to determine if acupuncture can be recommended as a primary strategy for weight loss.
1 Use of complementary and alternative therapies by overweight and obese adults. Bertisch SM, Wee CC, McCarthy EP. Obesity (Silver Spring). 2008 Jul;16(7):1610-5. Epub 2008 May 1. Available at: http://www.nature.com/oby/journal/v16/n7/pdf/oby2008239a.pdf
2 Use of complementary and alternative medicine for weight control in the United States. Sharpe PA, Blanck HM, Williams JE, Ainsworth BE, Conway JM. J Altern Complement Med. 2007 Mar;13(2):217-22.
3 National Center for Complementary and Alternative Medicine. Yoga for Health: An Introduction, NCCAM Publication No. D412, May 2008. Available at: http://nccam.nih.gov/health/yoga/introduction.htm
4 Yoga practice is associated with attenuated weight gain in healthy, middle-aged men and women. Kristal AR, Littman AJ, Benitez D, White E. Altern Ther Health Med. 2005 Jul-Aug;11(4):28-33.
5 Development and validation of the mindful eating questionnaire. Framson C, Kristal AR, Schenk JM, Littman AJ, Zeliadt S, Benitez D. J Am Diet Assoc. 2009 Aug;109(8):1439-44. Author manuscript at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2734460/pdf/nihms136809.pdf
6 Acupuncture. Vickers A, Wilson P, Kleijnen J. Qual Saf Health Care. 2002 Mar;11(1):92-7. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1743552/pdf/v011p00092.pdf
7 Stimulation of auricular acupuncture points in weight loss. Richards D, Marley J. Aust Fam Physician. 1998 Jul;27 Suppl 2:S73-7.
8 Failure of acupuncture in the treatment of obesity: a pilot study. Mazzoni R, Mannucci E, Rizzello SM, Ricca V, Rotella CM. Eat Weight Disord. 1999 Dec;4(4):198-202.
9 Acupuncture for obesity: a systematic review and meta-analysis. Cho SH, Lee JS, Thabane L, Lee J. Int J Obes (Lond). 2009 Feb;33(2):183-96. Epub 2009 Jan 13.