To systematically review sham or placebo-controlled trials of acupuncture or acupressure in obesity.

CISCOM and MEDLINE (from 1966 to 1996) were searched and bibliographies of retrieved papers were examined for further relevant articles.

Study designs of evaluations included in the review

Randomised controlled trials (RCTs) were included.

Specific interventions included in the review

Unilateral ear acupuncture using permanant needles; bilateral ear acupuncture using permanant needles; sham or placebo acupuncture using permanant needles; sessions of ear acupuncture at various points; acupressure device in the ear; acupressure device on wrist.

Participants included in the review

Two trials involved obese volunteers, one trial involved volunteers and one trial involved obese women.

Outcomes assessed in the review

The outcomes assessed were body weight reduction and appetite.

How were decisions on the relevance of primary studies made?

All sham and placebo-controlled studies of the use of acupuncture or acupressure as an aid for body weight loss in humans, were included. There are no details of how these decisions were reached.

The methodological quality of the studies was scored according to the scale proposed by Kleijnen et al., with points awarded for the use of, e.g. power calculations, randomisation, blinding, compliance and validated outcomes. The maximum score possible was 100 points. The authors do not state how the papers were assessed for quality, or how many of the authors performed the quality assessment.

The authors do not state how the data were extracted for the review, or how many of the authors performed the data extraction.

How were the studies combined?

A narrative synthesis was undertaken.

How were differences between studies investigated?

It is noted that the studies differ in terms of treatment modality, treatment period, study sample and trial design.

Four RCTs (270 participants) were included.

The 2 trials of low methodological quality, which primarily assessed hunger, had positive results; the 2 trials judged to be of greater methodological quality, which measured body weight, found no differences between treatment and control.

There is no clear evidence to show that either acupuncture or acupressure is effective in reducing appetite or body weight. Claims that these forms of treatment have specific effects on these conditions are not based on well-performed clinical trials.

Well-designed clinical trials, which have the power to provide a definitive answer as to whether or not acupuncture leads to a significantly greater reduction of appetite or body weight than an indistinguishable sham procedure, need to be conducted.

This review clearly illustrates the importance of considering methodological quality when evaluating RCTs. However, the databases searched may not be the best sources for trials of complementary medicine, and the lack of details about the review processes used by the author prevents proper assessment of the quality of this review.

Kleijnen J, Knipschild P, Ter Riet G. Clinical trials of homoeopathy. BMJ 1991;302:316-32.

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.