Traditional Chinese Medicine Interventions for Overweight and Obesity in Adults: An Umbrella Review and Evidence Map

Abstract

Background

Traditional Chinese medicine (TCM) is widely used for weight management, but the reliability and comparability of the available review-level evidence remain uncertain. This umbrella review evaluated the methodological quality, certainty, and quantitative findings of systematic reviews and meta-analyses of TCM interventions for adults with overweight or obesity.

Methods

We searched PubMed, Embase, the Cochrane Library, CNKI, Wanfang, CBM, and VIP for systematic reviews and meta-analyses of randomized controlled trials. Methodological quality and certainty of evidence were evaluated using AMSTAR-2 and GRADE. Primary-study overlap was assessed using a citation matrix and the corrected covered area (CCA). Mean differences (MDs) were pooled only when outcome units were clinically compatible; standardized effects were reported narratively and were not combined with MDs. Random-effects models and leave-one-out analyses were used for body weight and body mass index (BMI).

Results

Twelve systematic reviews or meta-analyses were retained. They contained 254 primary-study occurrences and a non-unique review-level participant total of 19,795. Citation matching identified 155 unique primary studies, producing a CCA of 5.81%, which indicated moderate overlap. In MD-only analyses, TCM interventions were associated with reductions in body weight (overall MD = −3.11 kg, 95% CI −4.05 to −2.16; I² = 90.9%) and BMI (overall MD = −1.26 kg/m², 95% CI −1.61 to −0.90; I² = 91.0%).The body-weight and BMI results remained statistically significant in leave-one-out analyses. For BMI, external therapies, TCM exercise, and the herbal-medicine subgroup all showed significant pooled effects.

Conclusion

TCM interventions may improve body weight and BMI in adults with overweight or obesity. However, substantial heterogeneity, overlap between reviews, inconsistent outcome reporting, and predominantly low-to-moderate certainty limit confidence in the estimates. The current evidence is insufficient to support definitive treatment rankings or strong clinical recommendations.

Introduction

In recent decades, obesity has emerged as a major global health challenge, largely driven by sedentary lifestyles, calorie-dense diets, and genetic predisposition.^1,2 It carries significant health risks, markedly increasing the incidence of chronic conditions such as cardiovascular disease, type 2 diabetes, hypertension, stroke, and certain malignancies.^3,4 Consequently, addressing the rising prevalence of obesity is vital for safeguarding public health and alleviating the burden on healthcare systems. While a diverse array of therapeutic modalities has emerged—spanning surgical, pharmacological, and behavioral interventions,^5,6 each approach is constrained by specific limitations.

For instance, although bariatric surgery remains the most effective and durable intervention for severe obesity,^7,8 its clinical utility is tempered by perioperative risks such as infection and hemorrhage, as well as long-term nutritional deficiencies.⁹ Pharmacotherapies, including glucagon-like peptide-1 (GLP-1) receptor agonists, offer a potent alternative by suppressing appetite; however, they may induce gastrointestinal distress, and their long-term safety profiles remain under investigation.^10,11 Furthermore, while lifestyle interventions are the cornerstone of management,¹² their success is heavily contingent upon sustained patient adherence.

Contrasting with the focal metabolic perspective of modern biomedicine, Traditional Chinese Medicine (TCM) conceptualizes obesity as a systemic manifestation of internal disharmony and disrupted Qi flow—a holistic framework informed by millennia of clinical practice.¹³ TCM classifies obesity into distinct syndrome patterns (Zheng), such as Dampness-Phlegm Accumulation, Spleen Qi Deficiency, Liver Qi Stagnation, and Yang Deficiency.^14,15 Rather than focusing on isolated symptomatic relief, TCM offers a multi-target and holistic regulatory strategy, which may provide a more sustainable metabolic reset compared to single-pathway pharmacological treatments. Through a multimodal repertoire, including tailored herbal prescriptions, acupuncture, and mind-body practices like Tai Chi or Baduanjin. By integrating constitutional analysis with behavioral support, TCM provides a personalized framework for sustainable weight management.^16,17

Despite this potential, most existing reviews have focused on isolated TCM interventions, lacking an integrated synthesis across different modalities. To address this gap, an updated umbrella review of systematic reviews and meta-analyses is warranted to synthesize current evidence, evaluate its quality, and provide a comprehensive understanding of TCM’s therapeutic value in managing overweight and obesity.

Methods

Registration of the Review

This review protocol had been registered in PROSPERO (CRD42024551788). The conduct and reporting of the review followed the Preferred Reporting Items for Overviews of Reviews (PRIOR) guidelines, while the protocol was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and Preferred Reporting Items for Overviews of reviews (PRIOR) checklists.^18,19

Search Strategy

We searched PubMed, Embase, the Cochrane Database of Systematic Reviews, CNKI, Wanfang, CBM, and VIP from inception to 1 August 2026. MeSH terms and free-text terms for overweight, obesity, TCM, and individual TCM interventions were combined with systematic-review and meta-analysis terms. Reference lists of eligible reviews were also screened. The complete English-language search strategies and the original Chinese strategy with an English translation are provided in Supplementary Appendix 1.

Eligibility Criteria

This umbrella review was structured based on the PICOS framework:

• Population: adults aged 18 years or older with overweight or obesity. No upper age limit was applied. The previously stated upper limit of 65 years was removed because it did not reflect the populations of the source reviews; this correction is reported as a protocol deviation.

• Intervention: oral traditional Chinese herbal medicine, TCM external therapies (including acupuncture, auriculotherapy, moxibustion, cupping, massage, and acupoint catgut embedding), or traditional Chinese exercise (including Tai Chi, Baduanjin, and Qigong).

• Comparison: placebo or sham treatment, lifestyle or basic treatment, active conventional treatment, or no treatment.

• Outcomes: body weight, BMI, body fat, waist circumference, hip circumference, waist-to-hip ratio, glycaemic outcomes, lipid outcomes, blood pressure, and adverse events.

• Study design: systematic reviews or meta-analyses of randomized controlled trials. Reviews that included non-randomized studies were eligible only when RCT data were separately extractable.

Reviews were excluded if the target population was not restricted to participants with overweight or obesity, if RCT data could not be separated, if quantitative outcome data were unavailable, or if the report was not in English or Chinese. Review overlap was examined using GROOVE and the corrected covered area (CCA).²⁰ The detailed GROOVE overlap analyses are provided in Supplementary Data File 1. Overlapping reviews were not selected solely on recency. Selection followed a hierarchy based on direct relevance to the PICOS question, methodological quality (AMSTAR-2), comprehensiveness of the search and eligible RCT set, recency of the search date, availability of extractable outcome data, and unique contribution (for example, a distinct intervention, outcome, or dose-response analysis). Similar structured approaches to the synthesis of review-level evidence have been applied in published umbrella reviews.²¹

• When two or more reviews addressed the same intervention and outcome, the review with the strongest combination of methodological quality, relevance, comprehensiveness, and currency was selected for quantitative synthesis. An older review could be retained when it was methodologically stronger, included a larger eligible evidence base, or reported a unique analysis not available in the newer review.

• When overlapping reviews contributed complementary data, both could be retained in the umbrella review and evidence map, but duplicated primary studies were considered when interpreting certainty and pooled review-level estimates.

• The selection decisions and reasons for excluding otherwise relevant reviews are detailed in Supplementary Appendix 3 (Supplementary Table S2).

Study Selection and Data Extraction

Two reviewers (XYH and GY) independently conducted the study screening and data extraction. Titles and abstracts were initially screened, followed by a full-text assessment to determine final eligibility. Discrepancies between reviewers were resolved through discussion, and unresolved issues were adjudicated by the third reviewer (ZHM).

Data from eligible systematic reviews and meta-analyses were extracted using a standardized Excel form, which included information on the first author, publication year, type of TCM intervention, control group, number of included studies, total sample size, intervention duration, outcome measures, and methods of quality assessment. Any disagreements during the extraction process were resolved by consensus.

Quality Assessment

The methodological quality of each included review was assessed using the AMSTAR-2 checklist,²² which covers 16 critical and non-critical domains. Based on the evaluation, reviews were classified into four levels of overall quality: high, moderate, low, or very low, in accordance with AMSTAR-2 guidance. Detailed AMSTAR-2 assessments of the included reviews are provided in Supplementary Appendix 4.

To further evaluate the strength and reliability of the evidence, the certainty of outcomes was appraised using the GRADE rating.²³ Key domains—including risk of bias, inconsistency, indirectness, imprecision, and potential publication bias—were systematically examined. Two reviewers (XYH and GY) independently conducted the assessments, and any discrepancies were resolved through the third reviewer (ZHM). Detailed GRADE assessments are provided in Supplementary Appendix 5.

Evidence Map

The evidence map used AMSTAR-2 methodological quality on the horizontal axis and GRADE certainty on the vertical axis. Each bubble represented one included systematic review or meta-analysis, and bubble size represented the review-level sample size. The upper-right area was labelled as a higher-confidence evidence area and the lower-left area as evidence requiring cautious interpretation. These labels describe confidence in the evidence and do not constitute formal clinical recommendations.

Statistical Analysis

All quantitative syntheses were performed using R. Review-level effects were pooled as mean differences (MDs) when the outcome was reported in a common clinically interpretable unit (for example, kg for body weight and kg/m² for BMI). Standardized mean differences or Hedges’ g were not combined with MDs and were summarized narratively. Random-effects models using the DerSimonian–Laird estimator were applied. Heterogeneity was assessed using Cochran’s Q and I². Leave-one-out analyses were conducted for the overall body-weight and BMI analyses and for subgroups containing at least three reviews. Outcomes with unclear or incompatible measurement units were not pooled. Because each synthesis included fewer than ten reviews, funnel-plot asymmetry tests were not performed. Primary-study overlap was summarized using CCA = (N − r)/[r(c − 1)], where N is the total number of study occurrences, r is the number of unique primary studies, and c is the number of included reviews. Exploratory review-level regression analyses were interpreted as hypothesis-generating only.

Result

Search Results

The reconstructed seven-database search identified 754 records. After removal of 214 duplicate records, 540 unique records were screened; 459 were excluded at title/abstract stage. Eighty-one reports were assessed for eligibility and representative-review selection. Sixty-nine were excluded or not retained: 17 because of population, age, or comorbidity mismatch; 8 because of intervention, design, or outcome mismatch; and 44 after the prespecified overlap, recency, and methodological-quality selection process. Twelve reviews were included. The study-selection process is summarized in Figure 1. During source verification, Xu et al (2015)²⁴ was excluded because it evaluated Chinese herbal formulas for metabolic syndrome and did not require all participants to have overweight or obesity. SY Kim et al (2018)²⁵ was retained, but its 32 intervention arms represented 27 RCTs and its Hedges’ g estimate was not combined with MDs. Liu Yanping (2025)²⁶ was added as the representative network meta-analysis of acupuncture modalities. The 12 reviews reported 254 primary-study occurrences and 19,795 participants; the participant total is not unique because primary studies overlapped.

Figure 1.

PRISMA-style flow diagram for study identification, eligibility assessment, and representative-review selection. The flow combines conventional eligibility exclusions with the prespecified overlap, recency, and quality selection used for highly overlapping umbrella-review evidence.

A citation matrix was reconstructed for the final included-review set. The 254 study occurrences represented 155 unique primary studies, yielding an overall CCA of 5.81%, classified as moderate overlap. Exact citation matching showed that none of the 50 RCTs in Liu Yanping (2025) duplicated a primary publication in Li Mengmeng (2023)²⁷ or Chen et al (2016)²⁸; all other potentially overlapping retained external-therapy reviews had also been resolved by citation or comparator-structure checks. The CCA and representative-review selection were used to prevent duplicated primary evidence from being interpreted as independent confirmation. Full details of the review-selection and overlap audit are provided in Supplementary Data File 1, including the “Read_Me”, “Final_CCA”, “Included_reviews”, “Excluded_not_retained”, “Liu50_overlap_tracker”, “Li2023_overlap_audit”, “Chen2016_overlap_audit”, and “Representative_selection” tabs.

The 12 included reviews were published between 2010 and 2025 and evaluated TCM external therapies, traditional Chinese herbal medicine, and traditional Chinese exercise.^25–36 Intervention durations generally ranged from 2 to 24 weeks, although duration was not consistently reported in the newly included network meta-analysis. Table 1 presents the final review characteristics, including the corrected RCT count for SY Kim et al (2018)²⁵ and the addition of Liu Yanping (2025).²⁶

Table 1.

Summary of Characteristics and Evaluation Results of Included Systematic Reviews of TCM for Overweight and Obesity (N = 12)

Source	TCM Intervention	Comparator(s)	RCTs	Sample	Duration	Outcomes	AMSTAR-2/GRADE
Kevin Hua 202436	Auriculotherapy	Basic therapies / placebo	22	1333	3–12 weeks	BW; BMI; BF; WC; adverse events	Moderate / Moderate
Hainan Gao 202433	TCM exercise	Daily activities / basic therapies	10	420	8–24 weeks	BW; BMI; WC; HC; adverse events	Moderate / Low
Ze Yang 202334	TCM exercise	Health education / none / basic therapies	10	701	10–24 weeks	BW; BMI; WC; HC; WHR	Low / Low
Cho WC 201835	Acupoint catgut embedding	Sham acupoint catgut embedding	5	272	4–12 weeks	BW; BMI	Low / Low
Seohyun Park 202232	Traditional Chinese herbal medicine	Placebo / diet and exercise / Western medicine	16	1052	4–12 weeks	BW; BMI; WC; HC; WHR	Moderate / Low
Zhige Wen 202231	Traditional Chinese herbal medicine	Placebo / no treatment	25	1947	3–24 weeks	BW; BMI; WC; HC; WHR; TC; TG; HDL-C; LDL-C; BP; FPG; HbA1c	Moderate / Low
SY Kim 201825	Acupuncture	Sham / lifestyle / no treatment	27 RCTs (32 arms)	2219	4–24 weeks	BW and BMI reported as Hedges’ g	High / High
Xinyu Zhao 202430	Acupuncture	Diet control / exercise	25	2018	4–12 weeks	BW; BMI; WC; BF; FPG; FINS; HOMA-IR; TC; TG; HDL-C; LDL-C; adverse events	High / Moderate
Mengmeng Li 202327	Acupuncture	Sham / lifestyle / Western medicine / basic therapies	35	2766	2–16 weeks	BW; BMI; WC; HC; WHR	Moderate / Moderate
Yu Zhi 201029	Acupuncture	Western medicine	8	958	4–12 weeks	Efficacy rate	Moderate / Low
Chen X 201628	Acupuncture	Sham / lifestyle / Western medicine	21	1929	3–13 weeks	Efficacy rate; BW; BMI; adverse events	Moderate / Moderate
Liu Yanping 202526	Fourteen acupuncture modalities	Active acupuncture modalities / Western medicine	50	4180	Not consistently reported	Efficacy rate; BW; BMI; WC; WHR; TC; TG; adverse events; network SMDs	Low / Low

Abbreviations: TCM, traditional Chinese medicine; BW, body weight; BMI, body mass index; BF, body fat; WC, waist circumference; HC, hip circumference; WHR, waist-to-hip ratio; TC, total cholesterol; TG, triglycerides; FPG, fasting plasma glucose; FINS, fasting insulin; HOMA-IR, homeostatic model assessment for insulin resistance; AMSTAR-2, A Measurement Tool to Assess Systematic Reviews 2; GRADE, Grading of Recommendations Assessment, Development and Evaluation.

Quality Assessment

According to AMSTAR-2, 2 of 12 reviews (16.7%) were rated high quality, 7 (58.3%) moderate quality, and 3 (25.0%) low quality; none was rated very low. The most frequent limitations involved protocol registration, provision of excluded-study lists, and discussion of the potential effect of bias. Detailed assessments are provided in Supplementary Appendix 4.

GRADE ratings used for the evidence map were high for 1 of 12 reviews (8.3%), moderate for 4 (33.3%), and low for 7 (58.3%). Downgrading was mainly related to risk of bias, inconsistency, and imprecision. These review-level categories are used only to visualize the maturity of the evidence; certainty remains outcome-specific. Detailed assessments are provided in Supplementary Appendix 5.

Evidence Map

The distribution of methodological quality, certainty of evidence, and review-level sample size is shown in Figure 2. External-therapy reviews occupied a broad range of methodological-quality and certainty categories, including the only high-certainty review. Herbal-medicine and TCM-exercise reviews were concentrated mainly in low-certainty regions. After addition of Liu Yanping (2025),²⁶ the exploratory association between review-level sample size and GRADE category was attenuated and was no longer statistically significant (Spearman ρ = 0.53, P = 0.076). This ecological analysis should not be interpreted causally.

Figure 2.

Evidence map of 12 included systematic reviews and meta-analyses. (A) maps AMSTAR-2 methodological confidence against the review-level GRADE category used for visualization; bubble size represents review-level sample size. (B) shows the exploratory association between sample size and GRADE category (Spearman ρ = 0.53, P = 0.076).

Results

Meta and Subgroup Analysis

1. Body weight and BMI: MD-only random-effects synthesis included nine reviews for body weight and nine reviews for BMI. SY Kim et al (2018)²⁵ was excluded from these pools because it reported Hedges’ g across standardized weight and BMI changes. For body weight, the overall pooled effect was −3.11 kg (95% CI −4.05 to −2.16; I² = 90.9%). The corresponding forest plot is shown in Figure 3. Subgroup estimates were −2.66 kg for external therapies (95% CI −4.01 to −1.31; I² = 92.9%), −4.59 kg for TCM exercise (95% CI −6.88 to −2.31; I² = 60.3%), and −3.15 kg for traditional Chinese herbal medicine (95% CI −4.89 to −1.41; I² = 88.8%). For BMI, the overall pooled effect was −1.26 kg/m² (95% CI −1.61 to −0.90; I² = 91.0%). The corresponding forest plot is shown in Figure 4. External therapies (MD −1.11 kg/m², 95% CI −1.61 to −0.61; I² = 92.8%), TCM exercise (MD −1.65 kg/m², 95% CI −2.30 to −1.00; I² = 68.1%), and traditional Chinese herbal medicine (MD −1.25 kg/m², 95% CI −1.77 to −0.73; I² = 82.7%) all showed statistically significant effects.

2. Network meta-analysis evidence: Liu Yanping (2025)²⁶ included 50 RCTs and compared 14 acupuncture modalities. Continuous outcomes were synthesized as network SMDs, so these estimates were included in the evidence map and narrative synthesis but were not combined with the kilogram or kg/m² MD pools. Although the review reported relative rankings among modalities, its methodological confidence and certainty were low; therefore, no treatment ranking was adopted as an umbrella-review recommendation.

Figure 3.

Random-effects forest plot of body-weight effects using MD-only review-level estimates. SY Kim et al (2018) and Liu Yanping (2025) were retained narratively but excluded from this pool because they reported standardized effects.

Figure 4.

Random-effects forest plot of BMI effects using MD-only review-level estimates. Xu et al (2015) was excluded after population verification; SY Kim et al (2018) and Liu Yanping (2025) were not combined with MDs.

Other anthropometric outcomes: Review-level estimates generally favoured TCM for body fat, waist circumference, hip circumference, and waist-to-hip ratio. The corresponding forest plots for body fat, waist circumference, hip circumference, and waist-to-hip ratio are provided in Supplementary Appendices 6–9, respectively. These outcomes were retained as secondary analyses, but their pooled interpretation remains exploratory because outcome definitions, units, and comparator structures varied across reviews.

• 3.Metabolic outcomes: After exclusion of Xu et al (2015)²⁴, no eligible review remained for systolic or diastolic blood pressure. Lipid estimates were not pooled because the extraction table suggested incompatible or insufficiently documented measurement scales across reviews. Fasting plasma glucose was reported by two eligible reviews, but a final pooled estimate should be presented only after confirmation that both reviews used the same unit.
• 4.Safety: Adverse events were inconsistently reported. Available reviews generally described mild, transient events related to acupuncture sites, auricular stimulation, or gastrointestinal symptoms, but the evidence was insufficient to establish comparative safety across TCM modalities.
• 5.Exploratory treatment-duration analysis: A review-level regression using the midpoint of the reported intervention-duration range showed a slope of 0.30 kg greater weight reduction per additional week (95% CI −0.02 to 0.62; P = 0.065; R² = 0.41). This analysis was not statistically significant and cannot identify an optimal treatment course because duration and effect were aggregated at review level and were confounded by intervention type and population differences. The corresponding review-level regression plot is provided in Supplementary Figure S1.

Publication Bias and Sensitivity Analysis

Publication bias and sensitivity analysis: Formal small-study-effect tests were not performed because each review-level synthesis contained fewer than ten reviews. Leave-one-out analyses showed that the overall body-weight and BMI findings remained statistically significant after omission of any single review. The external-therapy subgroups were also statistically significant in leave-one-out analyses. Sensitivity analysis was not informative for the two-review exercise and herbal-medicine subgroups, so those subgroup estimates should still be interpreted cautiously despite statistical significance.

Discussion

This umbrella review synthesized 12 systematic reviews and meta-analyses of TCM interventions for overweight or obesity. The corrected MD-only analyses suggest that TCM interventions may reduce body weight and BMI. Nevertheless, the very high heterogeneity, moderate primary-study overlap, sparse review-level subgroups, and predominantly low-to-moderate GRADE ratings substantially limit confidence in the magnitude and generalizability of these effects.

The Holistic Advantage in Anthropometric Improvement

The most consistent signal was observed for anthropometric outcomes rather than metabolic outcomes. External therapies and TCM exercise showed statistically significant pooled effects for both body weight and BMI, although between-review heterogeneity remained substantial. Traditional Chinese herbal medicine showed a statistically significant pooled effect on body weight, whereas its BMI estimate was imprecise and did not reach statistical significance after the ineligible metabolic-syndrome review was removed. Traditional Chinese herbal medicine showed statistically significant pooled effects on both body weight and BMI, although these estimates were based on only two reviews and showed substantial heterogeneity; therefore, they should be interpreted cautiously. Measures of abdominal and visceral adiposity, particularly waist circumference, are clinically relevant because of their established associations with cardiometabolic risk.^37–39 This change illustrates why source verification and transparent handling of review overlap are essential in umbrella reviews.

Paradoxical Metabolic Outcomes and the “Time-Lag” Effect

The metabolic evidence was less coherent. After source verification, blood-pressure evidence was no longer eligible, and lipid estimates could not be pooled reliably because measurement units were insufficiently documented or appeared incompatible across reviews. These findings should not be interpreted as evidence that TCM has no metabolic effect; rather, they demonstrate that current review-level reporting is inadequate for a trustworthy pooled estimate.

Intervention Duration: Most included studies lasted only 2 to 24 weeks. Longer-term weight-loss literature also highlights the importance of assessing the durability of treatment effects beyond short intervention periods.^40,41 While anthropometric changes are rapid and macroscopic, reversing chronic lipid dysregulation often requires longer-term physiological restructuring. Syndrome Differentiation (Zheng): The lack of standardized syndrome differentiation across many primary trials may have diluted the metabolic-specific effects of TCM. TCM’s strength lies in “personalized” medicine; applying a “one-size-fits-all” herbal formula or acupuncture protocol to all obese patients may improve general weight but fail to address the specific metabolic pathways of different syndrome patterns.^39–41 Potential mechanisms discussed in the broader literature include metabolic regulation by Chinese herbal medicine, modulation of the gut microbiota, and appetite-related effects of bioactive compounds.^42–44

Navigating the Evidence Map: Clinical Implications

The evidence map should be interpreted as a map of confidence, not a treatment-ranking tool. Reviews in the upper-right area had stronger methodological quality and certainty, but this does not directly establish superior clinical effectiveness. The exploratory association between sample size and GRADE category may reflect better precision and more mature evidence bases, but it is ecological and potentially confounded by review quality, intervention type, and publication year.

Limitations

Several limitations should be acknowledged. First, primary-study overlap means that the 254 study occurrences and the review-level participant total of 19,795 are not unique counts; the citation matrix identified 155 unique primary studies and an overall CCA of 5.81%. Second, substantial heterogeneity remained after subgrouping and leave-one-out analyses. Third, some source reviews used standardized effects while others used MDs, and these metrics could not be combined. Fourth, outcome units and reporting were insufficiently clear for several metabolic outcomes. Fifth, the correction from an upper age limit of 65 years to adults aged 18 years or older represents a protocol deviation made to align the eligibility statement with the actual source-review populations. Finally, the reconstructed library and representative-review selection depended partly on manual title and citation matching, although all final decisions and reasons are documented in the Supplementary Appendix 3 (Supplementary Table S2), with the detailed overlap audit provided in Supplementary Data File 1.

Several protocol deviations occurred during the revision process. The originally specified upper age limit of 65 years was removed to align the eligibility criteria with the actual adult populations represented in the included source reviews. In addition, the seven-database search library was reconstructed and updated to 1 August 2026, reviews with ineligible age or comorbidity populations were excluded, and overlapping reviews were selected according to the prespecified hierarchy of relevance, methodological quality, comprehensiveness, recency, and unique contribution. The final citation matrix was reconstructed and the CCA was recalculated accordingly. These deviations were undertaken to improve consistency between the protocol, the included evidence base, and the final analysis, and are reported transparently here.

Future reviews should preregister protocols, publish complete exclusion lists, use core outcome sets with clearly specified units, report adverse events consistently, and provide primary-study citation matrices to facilitate overlap assessment. Future RCTs should use adequate randomization and allocation concealment, longer follow-up, and standardized reporting of weight, body composition, metabolic outcomes, and treatment adherence.

Future TCM obesity research should use prospectively registered protocols, complete excluded-study lists, standardized core outcomes with explicit units, consistent adverse-event reporting, and transparent primary-study citation matrices. Evidence maps may help identify mature and underdeveloped areas, but current evidence does not justify a single preferred TCM modality or a definitive treatment hierarchy.

Conclusion

In conclusion, TCM interventions may reduce body weight and BMI in adults with overweight or obesity, but the certainty of the available evidence is insufficient for strong clinical recommendations. External therapies, TCM exercise, and traditional Chinese herbal medicine all showed significant pooled anthropometric effects in the corrected MD-only analyses, although heterogeneity remained substantial. These findings support further rigorous evaluation rather than immediate treatment prioritization.

Clinical and guideline decisions should consider the substantial heterogeneity, review overlap, methodological limitations, and limited safety reporting. Evidence maps can help identify where evidence is more mature, but they should not be interpreted as formal recommendation grades.

Large, well-reported RCTs and updated systematic reviews are needed to determine the durability, metabolic effects, safety, and comparative effectiveness of individual TCM modalities.

Funding Statement

No funding was received for this study.

Data Sharing Statement

The extracted data and analytic files supporting this umbrella review are available from either co-corresponding author upon reasonable request.

Author Contributions

Qin Qin: Conceptualization, Project administration, Writing – review & editing (lead). Yue Gou: Conceptualization, Investigation, Data curation, Writing – review & editing. Yunhui Xie: Methodology, Formal analysis, Investigation, Data curation, Visualization, Writing – original draft, Writing – review & editing. Hongmei Zhu: Methodology, Validation, Visualization, Writing – review & editing. Yanjun Liu: Investigation, Data curation, Supervision, Writing – review & editing.

All authors made a significant contribution to the work reported, whether in the conception, study design, execution, acquisition of data, analysis and interpretation, or in these areas; took part in drafting, revising, or critically reviewing the article; gave final approval of the version to be published; agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors reports no conflicts of interest in this work.