Acupuncture for overweight or obese people

Jie Li; Ying Lu; Mei Yu Shi; George Lenon; Qing Li; Yin Shi

doi:10.1002/14651858.CD008612.pub2

. 2018 Jul 24;2018(7):CD008612. doi: 10.1002/14651858.CD008612.pub2

Acupuncture for overweight or obese people

Jie Li ¹, Ying Lu ^1,^✉, Mei Yu Shi ², George Lenon ³, Qing Li ², Yin Shi ⁴

PMCID: PMC6513252

Abstract

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:

To assess the effects of acupuncture for overweight or obese people.

Background

Description of the condition

Overweight and obesity are defined as abnormal or excessive fat accumulation that presents a risk to health (WHO 2010). The fundamental cause of obesity and overweight is an energy imbalance between intake and expenditure of calories. The problem of overweight and obesity was labelled as a global epidemic in the World Health Organization (WHO) report ten years ago. Evidence is now emerging to suggest that the prevalence of the global epidemic ‐ "globesity" ‐ is increasing at an alarming rate in all countries (WHO 2010).

In the European region, prevalence has tripled in many countries since the 1980s (WHO 2008). In the African region, overweight and obesity have increased alarmingly since the early 1990s (WHO 2010). The prevalence of obesity in the Western Pacific region is well above 20% in most communities (WHO 2002). In 2008, Colorado was the only one state of the US which had a prevalence less than 20% while other 32 states had a prevalence of 25% or more (CDC 2009a). In the South‐East Asia region, data suggests that obesity is growing rapidly in affluent urban populations (WHO 2004). WHO further projects have shown that by 2015, approximately 2.3 billion adults will be overweight and more than 700 million will be obese (WHO 2006).

This is not only happening in the adult population but also in children and adolescents. According to the latest estimates from the International Obesity Task Force (IOTF), at least 155 million school‐age children worldwide are overweight. Around 30 to 45 million within that population are classified as obese ‐ accounting for 2% to 3% of the world's children aged 5 to 17. A further 22 million children are also affected according to previous IOTF global estimates based on WHO data for children less than five years of age (IOTF 2002). More than 75% of overweight and obese children live in low‐ and middle‐income countries (WHO 2010).

These global increases in overweight and obesity are attributable to a number of factors including: a global shift in diet towards increased intake of energy‐dense foods that are high in fat and sugars, a trend towards decreased physical activity due to the increasingly sedentary lifestyle and work, changing modes of transportation, and increasing urbanization. To assess the level of overweight and obesity, the WHO recommended using the body mass index (BMI), which is defined as the weight in kilograms divided by the square of the height in meters (kg/m²). At present, the WHO defines overweight as a BMI ≥ 25, and obesity as a BMI ≥ 30. The range of 18.50 to 24.99 of BMI is considered as normal. For the Asia‐Pacific region, the WHO recommended lower ranges (WHO 2000). BMI cut‐points provide a benchmark for individual assessment, but must be regarded as a rough guide for adults (WHO 2006). The BMI criteria used for children and teens are different from those used for adults.

In addition to the BMI, there are other measurements, such as waist circumference and waist‐to‐hip ratio (WHR) and body fat composition in identifying individuals at increased risk from obesity‐related illness.

Obesity has physical, psychological, and social consequences in adults and children (CDC 2009b). It increases risk of premature death and debilitating complaints which have an adverse effect on quality of life. It is also a major risk factor for non‐communicable diseases (NCDs) such as non‐insulin‐dependent diabetes mellitus (NIDDM), cardiovascular diseases (CVD) and cancer (WHO 2004). It may also result in many psychological disorders. Besides, overweight and obesity and their associated health problems lead to economic burdens to many societies. Obesity has already accounted for 2% to 8% of healthcare costs in several parts of the European region (WHO 2008); in the U.S in 2008, an estimate of the medical costs of obesity for 2010 reached $147 billion or 123 billion EUR (CDC 2009c).

Effective weight management is an important goal for every overweight and obese person. Presently, treatments for obesity suggested by the WHO are dietary management, physical activity, behavior modification, pharmacological treatment, surgery, traditional medicine and other treatments. Dietary restriction is the most conventional way for managing weight; adding physical activity and exercise to diet is more effective than either method alone in promoting fat loss; behavior treatment is regarded as an essential component of any adequate obesity‐treatment program. But all these three treatments have a common limitation: they show short term effects only. The concept of long‐term drug treatment has emerged as an adjunct to other weight‐loss therapies and as a way of helping to maintain body weight over time. However, its long‐term use has raised safety concerns in recent years. Weight management drugs do not cure obesity, so weight regain is expected when medication is discontinued. Furthermore, drugs for weight management have not yet been recommended for routine use but should be used under medical supervision. Bariatric surgery is considered to be the most effective way of reducing weight and may result in a sustained weight loss (WHO 2004). However, serious complications can occur, so patients should be selected carefully (Marielle 2008).

Currently, there are an increasing number of people who turn to complementary and alternative medicine (CAM). Although the use of acupuncture in the treatment of obesity is relatively new, it has become one of the most widely used therapies (Cho 2009).

Description of the intervention

Acupuncture originated in China thousands of years ago, constituting an integral part of Traditional Chinese Medicine (TCM). TCM, a traditional medical system, represents the wisdom of the Chinese people as well as a great treasure house of China. Its profound effects appear irreplaceable in maintaining good health for the Chinese people. TCM holds a unique view of the world and the human body which is different from Western medicine concepts. It has the 'concept of holism' and 'treatment according to syndrome differentiation'. From the viewpoint of TCM, a sound body is considered as a delicate balance between the two opposing, complementary and inseparable forces, Yin and Yang. The concept of Yin and Yang is rooted in the ancient Chinese philosophy: Yin represents cold, slow, weak, dark, or passive aspects, while Yang represents hot, excited, strong, bright, or active aspects. A major theory is that health is achieved by maintaining a balance of Yin and Yang and disease is caused by an imbalance of Yin and Yang (NCCAM 2009). TCM practitioners make a comprehensive analysis of a patient's condition by using four diagnostic methods: observing, hearing and smelling, asking and interviewing, and touching and palpating as well as applying individual or combined therapies.

As a part of TCM, acupuncture has been practiced in China for more than 5000 years and has gained popularity among Chinese people. Over the last few decades, its popularity has grown significantly in the world, spreading first throughout Asia and later to Europe and the Americas. After thousands of years of improvement and development, today's acupuncture techniques are quite different from ancient times. The term 'acupuncture', in modern times, describes the practice of stimulating the specific points on the human body by penetrating the skin with thin, solid, metallic needles that are manipulated by the hands and electrical stimulation.

Adverse effects of the intervention

It has been reported that acupuncture is associated with local pain, inflammation, or occasional infection after the treatment of overweight and obesity (Lacey 2003). Relatively few complications have been reported from the treatment using acupuncture in general (NCCAM 2009). However, adverse effects of using acupuncture need to be assessed systematically.

How the intervention might work

Up to now, the mechanism of acupuncture has not been clearly explained. According to Western medicine, the effects of acupuncture are probably the results of stimulating the nervous system to release chemicals which may in turn release other neurotransmitters or hormones producing the desired effects. This theory is supported by the basic research work which has shown acupuncture's effect on adrenocorticotropin (ACTH), insulin, thyroid hormones, growth stimulating hormone, beta‐endorphin, white blood cell production and plasma cholesterol levels. It is also believed that acupuncture may work on an electromagnetic bio‐information system (AMFI 2007).

In TCM, acupuncture regulates the balance of Yin and Yang, removes blockages of Qi (vital force) and Blood as well as dredging the meridian to restore and maintain the healthy condition. Being different from the common Western understandings, Qi and Blood are the fundamental substances that maintain the life activities of the human body. The meridian system is a distribution network for Qi and Blood, linking different areas of the body and making the body an organic whole. Its pathways make up a comprehensive yet complex body map that supplies vital energy to every part of the body. Acupoints are the specific sites through which the Qi of the internal organs and meridians is transported to the body surface. They are classified into three categories: acupoints of the fourteen meridians, extraordinary points and Ashi points. These are distributed on their related meridian pathways and are closely linked with the meridians. So acupoints should not be regarded as separate superficial points, but as special sites which are connected with each other, and through which the internal tissues and organs are related (Li 1999). Using acupuncture to restore and maintain the internal balance of body is accomplished by acupoint prescription and acupuncture manipulation.

The earliest written record of overweight and obesity in China is The Suwen (The Book of Plain Questions). TCM believes that overweight and obesity are significantly related to phlegm and dampness, stomach heat, poor spleen functioning, Qi deficiency and Blood stasis. TCM does not directly reduce excess weight but holds to a holistic concept by dealing with the underlying body changes which might have brought about the excess weight and fatness. The general principles of practicing acupuncture treatment are worked out under the guidance of the theories of TCM. According to TCM's understanding of overweight and obesity, the underlying principles for weight loss treatment are eliminating Phlegm, drying Damp, reinforcing Spleen and replenishing Qi. Strengthening the function of the Spleen and Stomach to carry out their transformation and transportation properly is the therapeutic principle that TCM adopts in treating overweight and obesity. Once the body's balance is restored, the metabolism will process food properly and excess Phlegm and Dampness will be resolved. Excess weight should no longer be a problem.

Why it is important to do this review

Due to the high prevalence of obesity worldwide and increasing popularity of acupuncture, this review aims to assess the effects and safety of acupuncture for overweight or obese people. Acupuncture appears to be effective, safe and cost‐effective for overweight or obese patients, but scientific evidence of its effectiveness and safety is still lacking.

In 2003, Lacey et al evaluated descriptive and controlled trials of acupuncture for enhancing weight loss (Lacey 2003). This publication provided a brief overview of the methods and mechanisms of acupuncture, a summary of descriptive and controlled studies of acupuncture in the treatment of obesity and an agenda for future research. Pittler et al aimed to assess the evidence from RCTs and systematic reviews of complementary therapies for reducing body weight (Pittler 2005). The evidence related to acupuncture and acupressure (one systematic review and three RCTs) were also included and reviewed. They found that the evidence for the effectiveness of acupuncture or acupressure for reducing body weight was not convincing.

Currently, there are seven systematic reviews or meta‐analyses of the evidence on the effects of acupuncture for overweight or obese people (Cho 2009; Liao 2014; Lin 2009; Liu Y 2011; Sui 2012; Yu 2010; Zhang 2013):

The aim of the first systematic review by Cho et al was to assess the acupuncture effects on body weight reduction and to evaluate adverse events of this therapy (Cho 2009). It has been suggested that acupuncture is an effective and a relatively safe treatment for obesity. However, the level of evidence was not fully convincing because of the poor methodological quality of trial reviews. The aim of the second systematic review was to systemically analyse the clinical effect of catgut embedding therapy for simple obesity (Liao 2014). This review suggested that clinical effectiveness of catgut embedding therapy is superior to other therapies in the treatment of simple obesity. The aim of the third systematic review was to evaluate the effects of acupuncture for treating obesity and to analyse the current situation of clinical studies (Lin 2009). This review concluded that besides reasonable diet and exercise, acupuncture was safe and effective for treating obesity. It may be more effective than pharmacological treatment. However, due to the limited quantity of literature and the low quality of some publications, higher quality and a larger scale of RCTs are needed. The purpose of Liu Y 2011 and Zhang 2013 was to evaluate the effects of catgut embedding therapy for simple obesity. Results suggested that catgut embedding therapy may be an effective and safe treatment for simple obesity. However, the quality of evidence was low and conclusions were not fully convincing. Sui 2012 examined the effectiveness, safety, rationale and incidence of relapse of weight gain using TCM (including acupuncture) to treat obesity. It suggested that Chinese herbal medicine and acupuncture were more effective than placebo or lifestyle modification in reducing body weight. They had a similar effectiveness to the Western anti‐obesity drugs but with fewer reported adverse effects. However, these conclusions were limited by small sample size and low quality of methodologies. The aim of Yu 2010 was to investigate the effects of acupuncture in treating obesity. Results of this study suggested that acupuncture may have certain advantages over routine medical treatment. As the quality of some studies was low, definite conclusions could not be drawn.

In summary, the previous systematic reviews have some limitations: firstly, search strategies have not been documented clearly and most of the search strategies were not up‐to‐date, therefore it is possible that relevant studies were overlooked and recent trials were not included. Secondly, the methodological quality of reviews did not appear to be rigorously controlled by a methodology panel and editorial team. Moreover, these publications can not be updated easily and reviewers can not change or adapt searches, methods, outcomes, conclusions and so on.

Objectives

To assess the effects of acupuncture for overweight or obese people.

Methods

Criteria for considering studies for this review

Types of studies

We included randomised controlled clinical trials (RCTs).

Types of participants

Male and female patients of any age or ethnic origin who were overweight or obese were eligible. The diagnosis of overweight and obese should preferably be consistent with the WHO definition. However, studies that used other generally accepted standards were also included.

Diagnostic criteria

The WHO defines overweight in adult Europeans as a body mass index (BMI) equal to or more than 25 (kg/m²), and obesity as a BMI equal to or more than 30; in Asians, overweight is defined as a BMI equal to or more than 23 and obesity as a BMI equal to or more than 25.

Diagnostic criteria will be potentially subjected to a sensitivity analysis.

Types of interventions

We planned to investigate the following comparisons of intervention versus control/comparator.

Intervention

Acupuncture

Acupuncture involves the act of needle insertion, although there are many other non‐invasive techniques for acupuncture point stimulation. Points may be selected according to traditional medical systems, symptoms, point selection based on the scientific relationships of point function and point prescription.

Comparator

No intervention
Placebo/sham acupuncture
Pharmacological treatments
Other non‐acupuncture interventions

Concomitant interventions had to be the same in the intervention and comparator groups to establish fair comparisons.

Exclusion criteria

Methods of stimulating acupoints which are quite different from traditional acupuncture, such as laser acupuncture and surface electrodes, will be excluded.

Trials that only compare different forms of acupuncture or different acupoints will be excluded.

Types of outcome measures

Primary outcomes

Weight loss (kg)
Morbidity
Adverse events

Secondary outcomes

Change in anthropometric measures other than weight loss (kg)
Physical activity
Health‐related quality of life
Socioeconomic effects
Blood pressure
Lipid levels
Glycaemic control

Method and timing of outcome measurement

Weight loss: measured as weight (kg) and measured at baseline and after treatment.
Change in anthropometric measures other than weight loss: measured as body mass index (BMI), lean body mass, body fat percentage and measured at baseline and after treatment.
Morbidity (all‐cause and obesity‐related): defined as coronary heart disease, diabetes and measured at baseline and after treatment.
Adverse events: such as local pain, inflammation, occasional infection and measured at baseline and after treatment.
Glycaemic control: glycosylated haemoglobin A1c (HbA1c) and measured at baseline and after treatment.
Lipid levels: as analysed by total cholesterol, LDL‐ and HDL‐cholesterol, triglycerides and measured at baseline and after treatment.
Blood pressure: systolic and diastolic blood pressure and measured at baseline and after treatment.
Physical activity: evaluated by a validated instrument such as International Physical Activity Questionnaire and measured at baseline and after treatment.
Health‐related quality of life: evaluated by a validated instrument such as WHOQoL‐BREF and measured at baseline and after treatment.
Socioeconomic effects: defined as hospital stay, costs of medicines and measured at baseline and after treatment.

Summary of findings

We present a 'Summary of findings' table reporting the following outcomes listed according to priority.

Weight loss (kg)
Morbidity
Adverse events
Anthropometric measures
Health‐related quality of life
Socioeconomic effects
Glycaemic control

Search methods for identification of studies

Electronic searches

We searched the following sources from inception of each database to the specified date and placed no restrictions on the language of publication.

Cochrane Library
- Cochrane Database of Systematic Reviews (CDSR) (2014, issue 4).
- Cochrane Central Register of Controlled Trials (CENTRAL) (2014, issue 4).
- Database of Abstracts of Reviews of Effects (DARE).
- Health Technology Assessment (HTA) reports.
MEDLINE (until April 2014)
EMBASE (until April 2014)
AcuTrials (http://acutrials.ocom.edu, until 10 September 2014)
ClinicalTrials.gov (until 10 September 2014)
ICTRP Search Portal (http://apps.who.int/trialsearch/) (until 18 August 2014))
AMED (until July 2010)
CBM (Chinese Biomedical Medicine Database) (until August 2014)
CNKI (China National Knowledge Infrastructure) (until August 2014)
VIP (VIP Database for Chinese Technical Periodicals) (until August 2014)
Digital Journal of Wanfang Data (until August 2014).

For details on search strategies see Appendix 1. After supplying the final review draft for editorial approval, the Cochrane Metabolic and Endocrine Disorders (CMED) Group performed a complete update search on all databases available at the editorial office and send the results to the review authors. Should we identified new studies for inclusion we evaluated these, incorporate the findings in our review and resubmitted for publication in The Cochrane Library (Beller 2013). The AMED database has not been searched since July 2010 because it is no longer available to the CMED.

Hand‐searched journals include Chinese Acupuncture & Moxibustion (until August 2014), Acupuncture Research (until August 2014), Journal of Clinical Acupuncture and Moxibustion (until August 2014), Shanghai Journal of Acupuncture and Moxibustion (until August 2014) and Journal of Traditional Chinese Medicine (until August 2014).

Searching other resources

Search in the reference lists has been conducted to identify other potentially eligible trials or ancillary publications that have included trials, (systematic) reviews, meta‐analyses and health technology assessment reports, to identify other potentially eligible trials or ancillary publications.

Data collection and analysis

Selection of studies

Two review authors (LY, LQ) independently scanned the abstract or title, or both, of every record retrieved, to determine which studies should be assessed further. We investigated the full text articles of all potentially relevant articles. We resolved any disagreements with this assessment through discussion and a decision was achieved based on consensus. If resolution of a disagreement was not possible, we categorised the study as a 'study awaiting classification' and contacted the study authors for clarification. We present an adapted PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analyses) flow diagram to showing the process of study selection (Figure 1) (Liberati 2009).

Data extraction and management

For studies that fulfilled inclusion criteria, two review authors (LY, LQ) independently exstracted key participant and intervention characteristics. We reported data on effectiveness outcomes and adverse events using standard data extraction form supplied by the CMED Group. We resolved any disagreements by discussion or, if required, by consultation with a third review author (SMY) (for details see Table 7; Appendix 2; Appendix 3; Appendix 4; Appendix 5; Appendix 6; Appendix 7; Appendix 8; Appendix 9; Appendix 10; Appendix 11). We reported interventions according to STRICTA (STRICTA 2010).

Table 1.

Overview of study populations

	Intervention(s) and comparator(s)	Sample size^a	Screened/eligible [N]	Randomised [N]	Safety [N]	ITT [N]	Analysed [N]	Finishing study [N]	Randomised finishing study [%]	Follow‐up time^b
(1) Chen 2009	I1: electro‐acupuncture	‐	60	20	‐	‐	20	20	100	3 wks
	I2: acupuncture			20	‐	‐	20	20	100
	C: no intervention			20	‐	‐	20	20	100
			total:	60	‐	‐	60	60	100	3 wks
(2) Chen 2013	I: catgut embedding therapy	‐	60	30	‐	‐	30	30	100	8 wks
	C: lifestyle control	‐	60	30	‐	‐	30	30	100	8 wks
			total:	60	‐	‐	60	60	100	8 wks
(3) Dang 2012	I1: electro‐acupuncture + lifestyle control	‐	90	30	30	‐	30	30	100	10 wks
	I2: computerized intermediate‐frequency therapy + electro‐acupuncture + lifestyle			30	30	‐	30	30	100
	C: lifestyle control			30	30	‐	30	30	100
			total:	90	‐	‐	90	90	100	10 wks
(4) Ding 2013	I: acupuncture + lifestyle control	‐	202	102	‐	‐	102	102	100	1 year
	C: lifestyle control	‐	202	100	‐	‐	100	100	100	1 year
			total:	202	‐	‐	202	202	100	1 year
(5) Duan 2013	I: acupuncture + lifestyle control	‐	90	45	45	45	45	45	100	13 wks
	C: foot holographic scraping therapy + lifestyle control	‐	90	45	45	45	45	45	100	13 wks
			total:	90	90	90	90	90	100	13 wks
(6) Feng 2014	I: catgut embedding therapy + lifestyle control	‐	96	72	‐	68	68	68	94	4 wks
	C: lifestyle control	‐	96	24	‐	22	22	22	92	4 wks
			total:	96	‐	90	90	90	94	4 wks
(7) Gucel 2012	I: acupuncture	‐	40	20	‐	20	20	20	100	5 wks
	C: sham acupuncture	‐	40	20	‐	20	20	20	100	5 wks
			total:	40	‐	40	40	40	100	5 wks
(8) Guo 2011	I1: catgut embedding therapy+ Chinese herbal medicine + lifestyle control	‐	90	30	30	‐	30	30	100	6 wks
	I2: catgut embedding therapy + lifestyle control			30	30	‐	30	30	100
	C: Chinese herbal medicine + lifestyle control			30	30	‐	30	30	100
			total:	90	90	‐	90	90	100	6 wks
(9)He 2012	I: acupuncture	‐	58	30	‐	‐	30	30	100	5 wks
	C: flash‐fire cupping therapy	‐	58	28	‐	‐	28	28	100	5 wks
			total:	58	‐	‐	58	58	100	5 wks
(10) Hsu 2009	I: auricular acupuncture	‐	60	30	30	23	23	23	77	6 wks
	C: sham auricular acupuncture	‐	60	30	30	22	22	22	73	6 wks
			total:	60	60	45	45	45	75	6 wks
(11) Hsu 2005a	I: electro‐acupuncture	70	54	27	27	24	24	24	89	13 wks
	C: sit‐up exercise	70	54	27	27	22	22	22	81	13 wks
			total:	54	54	46	46	46	85	13 wks
(12) Hsu 2005b	I: electro‐acupuncture	‐	72	24	24	22	22	22	92	6 wks
	C1: sit‐up exercise			24	24	20	20	20	83
	C2: no intervention			24	24	21	21	21	88
			total:	72	72	63	63	63	88	6 wks
(13) Lai 2010	I: acupuncture	‐	86	43	‐	‐	43	43	100	24 wks
	C: western medicine	‐	86	43	‐	‐	43	43	100	24 wks
			total:	86	‐	‐	86	86	100	24 wks
(14) Li 2009	I: catgut embedding therapy	‐	74	36	‐	‐	36	36	100	8 wks
	C: western medicine	‐	74	38	‐	‐	38	38	100	8 wks
			total:	74	‐	‐	74	74	100	8 wks
(15) Li 2014	I1: acupuncture	‐	153	49	49	‐	49	49	100	24 wks
	I2: acupuncture + western medicine			53	53	‐	53	53	100
	C: sham acupuncture + western medicine			51	51	‐	51	51	100
			total:	153	153	‐	153	153	100	24 wks
(16)Li L 2006	I1: electro‐acupuncture + lifestyle control	‐	90	30	‐	26	26	26	87	100 days
	I2: electro‐auricular acupuncture + auricular acupressure + lifestyle control			30	‐	29	29	29	97
	C: lifestyle control			30	‐	30	30	30	100
			total:	90	‐	85	85	85	94	100 days
(17) Lien 2012	I1: auricular acupuncture	‐	90	30	30	24	24	24	80	4 wks
	I2: auricular acupressure			30	30	24	24	24	80
	C: sham auricular acupuncture			30	30	23	23	23	77
			total:	90	90	71	71	71	79	4 wks
(18) Liu 2010	I1: catgut embedding therapy	‐	67	22	21	21	21	21	95	24 wks
	I2: catgut embedding therapy + Chinese herbal medicine			23	18	18	18	18	78
	C: Chinese herbal medicine			22	20	20	20	20	91
			total:	67	59	59	59	59	88	24 wks
(19) Liu 2011	I: electro‐acupuncture	‐	60	30	30	‐	30	30	100	8 wks
	C: low‐frequency electric stimulation therapy	‐	60	30	30	‐	30	30	100	8 wks
			total:	60	60	‐	60	60	100	8 wks
(20) Lu 2014	I: catgut embedding therapy + western medicine	‐	32	20	‐	‐	20	20	100	12 wks
	C: western medicine	‐	32	12	‐	‐	12	12	100	12 wks
			total:	32	‐	‐	32	32	100	12 wks
(21) Luo 2006	I1: electro‐acupuncture	‐	60	20	20	‐	20	20	100	3 courses (days unclear)
	I2: acupuncture			20	20	‐	20	20	100
	C: no intervention			20	20	‐	20	20	100
			total:	60	60	‐	60	60	100	3 courses (days unclear)
(22) Mi 2005	I: acupuncture	‐	120	80	‐	‐	80	80	100	12 wks
	C: lifestyle control	‐	120	40	‐	‐	40	40	100	12 wks
			total:	120	‐	‐	120	120	100	12 wks
(23) Pan 2010	I: acupuncture + lifestyle control	‐	74	48	‐	‐	48	48	100	5 wks
	C: sham acupuncture + lifestyle control	‐	74	26	‐	‐	26	26	100	5 wks
			total:	74	‐	‐	74	74	100	5 wks
(24) Rerksuppaphol 2011	I: electro‐acupuncture	‐	45	22	22	22	22	22	100	8 wks
	C: transcutaneous electrical acupoint stimulation	‐	45	23	23	23	23	23	100	8 wks
			total:	45	45	45	45	45	100	8 wks
(25) Schukro 2014	I: electro‐auricular acupuncture	‐	56	28	28	‐	22	22	79	10 wks
	C: sham auricular acupuncture	‐	56	28	28	‐	23	23	82	10 wks
			total:	56	56	‐	45	45	80	10 wks
(26) Shan 2008	I: acupuncture + lifestyle control		112	72	‐	‐	72	72	100	4 wks
	C: lifestyle control		112	40	‐	‐	40	40	100	4 wks
			total:	112	‐	‐	112	112	100	4 wks
(27) Shu 2011	I1: electro‐acupuncture + lifestyle control	‐	45	15	‐	‐	15	15	100	6 wks
	I2: auricular acupressure + lifestyle control			15	‐	‐	15	15	100
	C: moxibustion + lifestyle control			15	‐	‐	15	15	100
			total:	45	‐	‐	45	45	100	6 wks
(28) Su 2013	I: acupuncture + Chinese herbal medicine + lifestyle control	‐	80	40	‐	‐	40	40	100	12 wks
	C: Chinese herbal medicine + lifestyle control	‐	80	40	‐	‐	40	40	100	12 wks
			total:	80	‐	‐	80	80	100	12 wks
(29) Tao 2009	I: catgut embedding therapy + Chinese herbal medicine	‐	42	22	‐	‐	22	22	100	12 wks
	C: Chinese herbal medicine	‐	42	20	‐	‐	20	20	100	12 wks
			total:	42	‐	‐	42	42	100	12 wks
(30) Tao 2010	I1: catgut embedding therapy + Chinese herbal medicine	‐	61	22	‐	‐	18	18	82	12 wks
	I2: catgut embedding therapy			20	‐	‐	19	19	95
	C: Chinese herbal medicine			19	‐	‐	17	17	89
			total:	61	‐	‐	54	54	88	12 wks
(31) Tong 2011	I: acupuncture + lifestyle control	‐	118	76	‐	‐	76	76	100	5 wks
	C: acupuncture + lifestyle control	‐	118	42	‐	‐	42	42	100	5 wks
			total:	118	‐	‐	118	118	100	5 wks
(32) Wang 2014	I: acupuncture + lifestyle control	‐	100	50	‐	‐	50	50	100	24 wks
	C: Chinese herbal medicine + lifestyle control	‐	100	50	‐	‐	50	50	100	24 wks
			total:	100	‐	‐	100	100	100	24 wks
(33) Wang X 2006	I1: electro‐acupuncture	‐	60	20	‐	‐	20	20	100	6 wks
	I2: electro‐acupuncture + Chinese herbal medicine			20	‐	‐	20	20	100
	C: Chinese herbal medicine			20	‐	‐	20	20	100
			total:	60	‐	‐	60	60	100	6 wks
(34) Wu 2009	I: catgut embedding therapy + lifestyle control	‐	60	30	‐	‐	30	30	100	12 wks
	C: western medicine + lifestyle control	‐	60	30	‐	‐	30	30	100	12 wks
			total:	60	‐	‐	60	60	100	12 wks
(35) Xing 2009	I: acupuncture + lifestyle control	‐	67	33	‐	31	31	31	94	51 days
	C: lifestyle control	‐	67	34	‐	30	30	30	88	51 days
			total:	67	‐	61	61	61	91	51 days
(36) Xiong 2011	I: acupuncture	‐	54	18	‐	‐	18	18	100	8 wks
	C1: needle‐knife			18	‐	‐	18	18	100
	C2: western medicine			18	‐	‐	18	18	100
			total:	54	‐	‐	54	54	100	8 wks
(37) Xu 2008	I: catgut embedding therapy + lifestyle control	‐	60	30	‐	‐	30	30	100	8 wks
	C: Chinese herbal medicine + lifestyle control	‐	60	30	‐	‐	30	30	100
			total:	60	‐	‐	60	60	100	9 wks
(38) Xu 2011	I: acupuncture	‐	150	100	‐	‐	100	100	100
	C: western medicine	‐	150	50	‐	‐	50	50	100
			total:	150	‐	‐	150	150	100	9 wks
(39) Yan 2011	I: acupuncture + lifestyle control	‐	120	60	‐	57	57	57	95	6 wks
	C: bian‐stone + lifestyle control	‐	120	60	‐	57	57	57	95	6 wks
			total:	120	‐	114	114	114	95	6 wks
(40) Ye 2010	I: electro‐acupuncture + lifestyle control	‐	96	48	‐	‐	48	48	100	12 wks
	C: lifestyle control	‐	96	48	‐	‐	48	48	100	12 wks
			total:	96	‐	‐	96	96	100	12 wks
(41) Yin 2006	I: acupuncture	‐	108	50	50	‐	50	50	100	12 wks
	C: acupoint plaster application	‐	108	58	58	‐	58	58	100	12 wks
			total:	108	108	‐	108	108	100	12 wks
(42) Zhang 2005	I: acupuncture	‐	60	30	‐	‐	30	30		4 wks
	C: magnet plastering therapy	‐	60	30	‐	‐	30	30		4 wks
			total:	60	‐	‐	60	60		4 wks
(43) Zhang 2011	I1: electro‐acupuncture + lifestyle control	‐	78	26	‐	‐	26	26	100	8 wks
	I2: electro‐acupuncture + computerized intermediate‐frequency + lifestyle control			26	‐	‐	26	26	100
	C: lifestyle control			26	‐	‐	26	26	100
			total:	78	‐	‐	78	78	100	8 wks
(44) Zhang 2012	I: electro‐acupuncture	‐	30	15	15	‐	15	15	100	4 wks
	C: sham acupuncture	‐	30	15	15	‐	15	15	100	4 wks
			total:	30	30	‐	30	30	100	4 wks
(45) Zhang Y 2007	I: electro‐acupuncture + lifestyle control	‐	64	32	‐	‐	32	32	100	8 wks
	C: lifestyle control	‐	64	32	‐	‐	32	32	100	8 wks
			total:	64	‐	‐	64	64	100	8 wks
(46) Zhao 2010	I: electro‐acupuncture + lifestyle control	‐	72	35	‐	‐	30	30	86	8 wks
	C: lifestyle control	‐	72	37	‐	‐	30	30	81	8 wks
			total:	72	‐	‐	60	60	83	8 wks
(47) Zhao 2011	I: electro‐acupuncture + transcutaneous electrical acupoint stimulation	‐	70	35	‐	‐	35	35	100	4 wks
	C: sham acupuncture + transcutaneous electrical acupoint stimulation	‐	70	35	‐	‐	35	35	100	4 wks
			total:	70	‐	‐	70	70	100	4 wks
(48) Zhu 2007	I1: acupuncture+ auricular acupuncture + lifestyle control	‐	120	42	‐	‐	42	42	100	12 wks
	I2: acupuncture+ auricular acupuncture			40	‐	‐	40	40	100
	C: lifestyle control			38	‐	‐	38	38	100
			total:	120	‐	‐	120	120	100	12 wks
*Grand total*	*All interventions*	61		2176				2116
	*All comparators*	50		1630				1578
	*All interventions and comparators*	101		3806				3694

	Intervention(s) [route, frequency, total dose/day]	Adequate^a intervention [Yes / No]	Comparator(s) [route, frequency, total dose/day]	Adequate^a comparator [Yes / No]
Chen 2009	I1: electro‐acupuncture	Y	No intervention	Y
Chen 2009	I2: acupuncture	Y	No intervention	Y
Chen 2013	Catgut embedding therapy	Y	Lifestyle control	Y
Dang 2012	I1: electro‐acupuncture + lifestyle control	Y	Lifestyle control	Y
Dang 2012	I2: computerized intermediate‐frequency therapy + electro‐acupuncture + lifestyle control	Y	Lifestyle control	Y
Ding 2013	Acupuncture + lifestyle control	Y	Lifestyle control	Y
Duan 2013	Acupuncture + lifestyle controlC	Y	Foot holographic scraping therapy + lifestyle control	Y
Feng 2014	Catgut embedding therapy + lifestyle control	Y	Lifestyle control	Y
Gucel 2012	Acupuncture	Y	Sham acupuncture	Y
Guo 2011	I1: catgut embedding therapy + Chinese herbal medicine + lifestyle control	Y	Chinese herbal medicine + lifestyle control	Y
Guo 2011	I2: catgut embedding therapy + lifestyle control	Y	Chinese herbal medicine + lifestyle control	Y
He 2012	Acupuncture	Y	Flash‐fire cupping therapy	Y
Hsu 2009	Auricular acupuncture	Y	Sham auricular acupuncture	Y
Hsu 2005a	Electro‐acupunctureI	Y	Sit‐up exercise	Y
Hsu 2005b	Electro‐acupuncture	Y	C1: sit‐up exercise	Y
Hsu 2005b	Electro‐acupuncture	Y	C2: no intervention	Y
Lai 2010	Acupuncture	Y	Western medicine	Y
Li 2009	Catgut embedding therapy	Y	Western medicine	Y
Li 2014	I1: acupuncture + western medicine	Y	Sham acupuncture + western medicine	Y
Li 2014	I2: acupuncture	Y	Sham acupuncture + western medicine	Y
Li L 2006	I1: electro‐acupuncture + lifestyle control	Y	Lifestyle control	Y
Li L 2006	I2: electro‐auricular acupuncture + auricular acupressure + lifestyle control	N	Lifestyle control	Y
Lien 2012	I1: auricular acupuncture	Y	Sham auricular acupuncture	Y
Lien 2012	I2: auricular acupressure	N	Sham auricular acupuncture	Y
Liu 2010	I1: catgut embedding therapy	Y	Chinese herbal medicine	Y
Liu 2010	I2: catgut embedding therapy + Chinese herbal medicine	Y	Chinese herbal medicine
Liu 2011	Electro‐acupuncture	Y	Low‐frequency electric stimulation therapy	Y
Lu 2014	Catgut embedding therapy + western medicine	Y	Western medicine	Y
Luo 2006	I1: electro‐acupuncture	Y	No intervention	Y
Luo 2006	I2: acupuncture	Y	No intervention	Y
Mi 2005	Acupuncture	Y	Lifestyle control	Y
Pan 2010	Acupuncture + lifestyle control	Y	Sham acupuncture + lifestyle control	Y
Rerksuppaphol 2011	Electro‐acupuncture	Y	Transcutaneous electrical acupoint stimulation	Y
Schukro 2014	Electro‐auricular acupuncture	Y	Sham auricular acupuncture	Y
Shan 2008	Acupuncture + lifestyle control	Y	Lifestyle control	Y
Shu 2011	I1: electro‐acupuncture + lifestyle control	Y	Moxibustion + lifestyle control	Y
Shu 2011	I2: auricular acupressure + lifestyle control	N	Moxibustion + lifestyle control	Y
Su 2013	Acupuncture + Chinese herbal medicine + lifestyle control	Y	Chinese herbal medicine + lifestyle control	Y
Tao 2009	Catgut embedding therapy + Chinese herbal medicine	Y	Chinese herbal medicine	Y
Tao 2010	I1: catgut embedding therapy + Chinese herbal medicine	Y	Chinese herbal medicine	Y
	I2: catgut embedding therapy	Y	Chinese herbal medicine	Y
Tong 2011	Acupuncture + lifestyle control	Y	Sham acupuncture + lifestyle control	Y
Wang 2014	Acupuncture + lifestyle control	Y	Chinese herbal medicine + lifestyle control	Y
Wang X 2006	I1: electro‐acupuncture	Y	Chinese herbal medicine	Y
Wang X 2006	I2: electro‐acupuncture + Chinese herbal medicine	Y	Chinese herbal medicine	Y
Wu 2009	Catgut embedding therapy + lifestyle control	Y	Western medicine + lifestyle control	Y
Xing 2009	Acupuncture + lifestyle control	Y	Lifestyle control	Y
Xiong 2011	Acupuncture	Y	C1: needle‐knife	Y
Xiong 2011	Acupuncture	Y	C2: western medicine	Y
Xu 2008	Catgut embedding therapy + lifestyle control	Y	Chinese herbal medicine + lifestyle control	Y
Xu 2011	Acupuncture	Y	Western medicine	Y
Yan 2011	Acupuncture + lifestyle control	Y	Bian‐stone + lifestyle control	Y
Ye 2010	Electro‐acupuncture + lifestyle control	Y	Lifestyle control	Y
Yin 2006	Acupuncture	Y	Acupoint plaster application	Y
Zhang 2005	Acupuncture	Y	Magnet plastering therapy	Y
Zhang 2011	I1: electro‐acupuncture + lifestyle control	Y	Lifestyle control	Y
Zhang 2011	I2: electro‐acupuncture + computerized intermediate‐frequency + lifestyle control	Y	Lifestyle control	Y
Zhang 2012	Electro‐acupuncture	Y	Sham acupuncture	Y
Zhang Y 2007	Electro‐acupuncture + lifestyle control	Y	Lifestyle control	Y
Zhao 2010	Electro‐acupuncture + lifestyle control	Y	Lifestyle control	Y
Zhao 2011	Electro‐acupuncture + transcutaneous electrical acupoint stimulation	Y	Sham acupuncture + transcutaneous electrical acupoint stimulation	Y
Zhu 2007	I1: acupuncture+ auricular acupuncture + lifestyle control	Y	Lifestyle control	Y
Zhu 2007	I2: acupuncture+ auricular acupuncture	Y	Lifestyle control	Y
"‐" denotes not reported ^aThe term 'adequate' refers to sufficient use of the intervention/comparator with regard to dose, dose escalation, dosing scheme, provision for contraindications and other features necessary to establish a fair contrast between intervention and comparator C: comparator; I: intervention; N: no; Y: yes

	Intervention(s) and comparator(s)	Duration of intervention (duration of follow‐up)	Description of participants	Study period [year to year]	Country	Setting	Ethnic groups [%]	Duration of disease [mean/range years (SD), or as reported]
Chen 2009	I1: electro‐acupuncture	3 wks (‐)	Adults with simple obesity	‐	China	Hospital outpatient clinic	Chinese: 100	2‐28
	I2: acupuncture
	C: no intervention
Chen 2013	I: catgut embedding therapy	8 wks (‐)	Adults with simple obesity	2012.7‐2012.12	China	Hospital outpatient clinic	Chinese: 100	60 (4)
	C: lifestyle control							60 (4)
Dang 2012	I1: electro‐acupuncture + lifestyle control	10 wks (‐)	Adults with simple obesity ‐ syndrome differentiation of TCM diagnosed as damp impediment due to stomach heat	2010.6‐2011.12	China	Hospital outpatient clinic	Chinese: 100	4 (4)
	I2: computerized intermediate‐frequency therapy + electro‐acupuncture + lifestyle control							5 (3)
	C: lifestyle control							6 (2)
Ding 2013	I: acupuncture + lifestyle control	5 wks (1 year)	Obese patients with type 2 diabetes mellitus	2010.1‐2012.1	China	Hospital inpatient and outpatient clinic	Chinese: 100	‐
	C: lifestyle control							‐
Duan 2013	I: acupuncture + lifestyle control	4 wks	Adults with simple obesity	2011.5‐2013.1	China	University	Chinese: 100	≤3 yrs 47% ≤10 yrs 36% ＞10 yrs 18%
	C: foot holographic scraping therapy + lifestyle control	5 wks	Adults with simple obesity			University		≤3 yrs 42% ≤10 yrs 45% ＞10 yrs 13%
Feng 2014	I: catgut embedding therapy + lifestyle control	4 wks (‐)	Adults with simple obesity	2012.5‐2013.8	China	Hospital outpatient clinic	Chinese: 100	9 (3)
	C: lifestyle control							8 (4)
Gucel 2012	I: acupuncture	5 wks (‐)	Female obese adults	2009.1‐2010.1	Turkey	Hospital outpatient clinic	‐ ‐	‐
	C: sham acupuncture							‐
Guo 2011	I1: catgut embedding therapy + Chinese herbal medicine + lifestyle control	6 wks (‐)	Adults with simple obesity	2010.1‐2011.3	China	outpatient clinic	‐	＜5 yrs 40% 5‐10 yrs 40% ＞10 yrs 20%
	I2: catgut embedding therapy + lifestyle control							＜5 yrs 43% 5‐10 yrs 43% ＞10 yrs 13%
	C: Chinese herbal medicine + lifestyle control							＜5 yrs 50% 5‐10 yrs 33% ＞10 yrs 17%
He 2012	I: acupuncture	5 wks (‐)	Adults with simple obesity	2010.7‐2012.3	China	University outpatient clinic	Chinese: 100	2‐5 yrs
	C: flash‐fire cupping therapy
Hsu 2009	I: auricular acupuncture	6 wks (‐)	Obese women	2006.1‐2006.12	China	Hospital outpatient clinic	‐	‐
	C: sham auricular acupuncture						‐	‐
Hsu 2005a	I: electro‐acupuncture	13 wks (‐)	Obese women	2002.1‐2002.12	China	Hospital outpatient clinic	‐	‐
	C: sit‐up exercise						‐	‐
Hsu 2005b	I: electro‐acupuncture	6 wks (‐)	Obese women	2002.7‐2003.6	China	Hospital outpatient clinic	‐	‐
	C1: sit‐up exercise						‐	‐
	C2: no intervention						‐	‐
Lai 2010	I: acupuncture	24 wks (‐)	Obesity‐type PCOS patients	2006.1‐2009.5	China	Hospital outpatient clinic	Chinese: 100	6 (3)
	C: western medicine							4 (2)
Li 2009	I: catgut embedding therapy	8 wks (‐)	Hypertriglyceridemia patients associated with obesity	2007.4‐2007.6	China	‐	Chinese: 100	3
	C: western medicine			2008.4‐2008.6				3
Li 2014	I1: acupuncture	24 wks (‐)	Obesity‐type PCOS patients	2010.9‐2011.9	China	Hospital outpatient clinic	Chinese: 100	4
	I2: acupuncture + western medicine							4
	C: sham acupuncture + western medicine							3
Li L 2006	I1: electro‐acupuncture + lifestyle control	100 days (‐)	Teenager simple obesity	2003.10‐2005.4	China	Hospital outpatient clinic	Chinese: 100	‐
	I2: electro‐auricular acupuncture + auricular acupressure + lifestyle control							‐
	C: lifestyle control							‐
Lien 2012	I1: auricular acupuncture	4 wks (‐)	Obese women	2009.8‐2010.3	China	Hospital outpatient clinic	‐	‐
	I2: auricular acupressure							‐
	C: sham auricular acupuncture							‐
Liu 2010	I1: catgut embedding therapy	12 wks (12 wks)	Obesity‐type PCOS patients	2007‐2008	China	Hospital outpatient clinic	Chinese: 100	5 (1)
	I2: catgut embedding therapy + Chinese herbal medicine							5 (2)
	C: Chinese herbal medicine							5 (1)
Liu 2011	I: electro‐acupuncture	8 wks (‐)	Patients with simple obesity	‐	China	University outpatient clinic	Chinese: 100	1‐5
	C: low‐frequency electric stimulation therapy							1‐5
Lu 2014	I: catgut embedding therapy + western medicine	12 wks (‐)	Obesity‐type PCOS patients	‐	China	Hospital outpatient clinic	Chinese: 100	5 (5)
	C: western medicine							5 (4)
Luo 2006	I1: electro‐acupuncture	3 courses (‐)	Patients with simple obesity	‐	China	‐	Chinese: 100	‐
	I2: acupuncture							‐
	C: no intervention							‐
Mi 2005	I: acupuncture	12 wks (12 wks)	Patients with simple obesity	‐	China	Hospital outpatient clinic	Chinese: 100	7
	C: lifestyle control							7
Pan 2010	I: acupuncture + lifestyle control	5 wks (‐)	Patients with simple obesity	2008.7‐2009.10	China	Hospital outpatient clinic	Chinese: 100	11 (8)
	C: sham acupuncture + lifestyle control							11 (8)
Rerksuppaphol 2011	I: electro‐acupuncture	8 wks (‐)	Overweight or obese women	2010.3‐2010.7	Thailand	Hospital outpatient clinic	‐	‐
	C: transcutaneous electrical acupoint stimulation							‐
Schukro 2014	I: electro‐auricular acupuncture	6 wks (4 wks)	Healthy, obese women	‐	Austria	University	‐	‐
	C: sham auricular acupuncture							‐
Shan 2008	I: acupuncture + lifestyle control	4 wks (‐)	Patients with simple obesity	‐	China	‐	Chinese: 100	0.5‐16
	C: lifestyle control
Shu 2011	I1: electro‐acupuncture + lifestyle control	6 wks (‐)	Women with simple obesity	‐	China	‐	Chinese: 100	‐
	I2: auricular acupressure + lifestyle control							‐
	C: moxibustion + lifestyle control							‐
Su 2013	I: acupuncture + Chinese herbal medicine + lifestyle control	12 wks (‐)	Obesity‐type PCOS patients	2011.1‐2012.6	China	Hospital outpatient clinic	Chinese: 100	6 (2)
	C: Chinese herbal medicine + lifestyle control							5 (3)
Tao 2009	I: catgut embedding therapy + Chinese herbal medicine	12 wks (‐)	Obesity‐type PCOS patients	2006.1‐2007.1	China	Hospital outpatient clinic	Chinese: 100	5 (2)
	C: Chinese herbal medicine							5 (2)
Tao 2010	I1: catgut embedding therapy + Chinese herbal medicine	12 wks (‐)	Obesity‐type PCOS patients	2007.2‐2008.2	China	Hospital outpatient clinic	Chinese: 100	‐
	I2: catgut embedding therapy							‐
	C: Chinese herbal medicine							‐
Tong 2011	I: acupuncture + lifestyle control	5 wks (‐)	Patients with simple obesity	2008.7‐2010.4	China	Hospital outpatient clinic	Chinese: 100	11 (7)
	C: sham acupuncture + lifestyle control							11 (8)
Wang 2014	I: acupuncture + lifestyle control	12 wks (12 wks)	Patients with simple obesity	‐	China	Hospital inpatient and outpatient clinic	Chinese: 100	16 (35)
	C: Chinese herbal medicine + lifestyle control							19 (42)
Wang X 2006	I1: electro‐acupuncture	6 wks (‐)	Patients with simple obesity	‐	China	Hospital outpatient clinic	Chinese: 100	‐
	I2: electro‐acupuncture + Chinese herbal medicine							‐
	C: Chinese herbal medicine							‐
Wu 2009	I: catgut embedding therapy + lifestyle control	4 wks (8 wks)	Patients with simple obesity	2008.8‐2009.5	China	Hospital outpatient clinic	Chinese: 100	8
	C: western medicine + lifestyle control
Xing 2009	I: acupuncture + lifestyle control	51 days (‐)	Patients with simple obesity	‐	China	Hospital outpatient clinic	Chinese: 100	‐
	C: lifestyle control							‐
Xiong 2011	I: acupuncture	8 wks (‐)	Patients with simple obesity	‐	China	Hospital outpatient clinic	Chinese: 100	‐
	C1: needle‐knife							‐
	C2: western medicine							‐
Xu 2008	I: catgut embedding therapy + lifestyle control	8 wks (‐)	Patients with simple obesity	2007.2‐2008.2	China	outpatient clinic	Chinese: 100	8
	C: Chinese herbal medicine + lifestyle control
Xu 2011	I: acupuncture	9 wks (‐)	diabetes and obese	2008.10‐2010.10	China	Hospital outpatient clinic	Chinese: 100	4 (0.1)
	C: western medicine							4 (0.2)
Yan 2011	I: acupuncture + lifestyle control	6 wks (‐)	Patients with simple obesity	‐	China	Hospital outpatient clinic	Chinese: 100	‐
	C: bian‐stone + lifestyle control							‐
Ye 2010	I: electro‐acupuncture + lifestyle control	12 wks (‐)	Patients with simple obesity	‐	China	Hospital outpatient clinic	Chinese: 100	1‐10
	C: lifestyle control
Yin 2006	I: acupuncture	12 wks (‐)	Patients with simple obesity	‐	China	Hospital inpatient and outpatient clinic	Chinese: 100	36 (6)
	C: acupoint plaster application							37 (10)
Zhang 2005	I: acupuncture	4 wks (‐)	Patients with simple obesity	2004.12‐2005.3	China	‐	Chinese: 100	‐
	C: magnet plastering therapy							‐
Zhang 2011	I1: electro‐acupuncture + lifestyle control	8 wks (‐)	Patients with simple obesity	2010.2‐2010.10	China	Hospital outpatient clinic	Chinese: 100	4 (4)
	I2: electro‐acupuncture + computerized intermediate‐frequency + lifestyle control							6 (3)
	C: lifestyle control							6 (3)
Zhang 2012	I: electro‐acupuncture	4 wks (‐)	Patients with simple obesity	‐	China	‐	Chinese: 100	‐
	C: sham acupuncture							‐
Zhang Y 2007	I: electro‐acupuncture + lifestyle control	8 wks (‐)	Patients with simple obesity	‐	China	Hospital outpatient clinic	Chinese: 100	‐
	C: lifestyle control							‐
Zhao 2010	I: electro‐acupuncture + lifestyle control	8 wks (‐)	Patients with simple obesity	2008.9‐2009.12	China	Hospital outpatient clinic	Chinese: 100	‐
	C: lifestyle control							‐
Zhao 2011	I: electro‐acupuncture + transcutaneous electrical acupoint stimulation	4 wks (‐)	Patients with simple obesity	‐	China	Hospital outpatient clinic	Chinese: 100	‐
	C: sham acupuncture + transcutaneous electrical acupoint stimulation							‐
Zhu 2007	I1: acupuncture+ auricular acupuncture + lifestyle control	12 wks (‐)	Patients with simple obesity	‐	China	Hospital outpatient clinic	Chinese: 100	‐
	I2: acupuncture+ auricular acupuncture							‐
	C: lifestyle control							‐
"‐" denotes not reported C: comparator; I: intervention; SD: standard deviation; PCOS: polycystic ovarian syndrome; TCM: Traditional Chinese Medicine; wks: weeks

	Intervention(s) and comparator(s)	Sex [female %]	Age [mean/range years (SD), or as reported]	HbA1c [%]	BMI [mean kg/m² (SD)]	Comedications/Cointerventions	Comorbidities
Chen 2009	I1: electro‐acupuncture	‐	‐	‐	‐	none	none
	I2: acupuncture	‐	‐	‐	‐	none	none
	C: no intervention	‐	‐	‐	‐	none	none
	all:	63	22‐58	‐	‐	none	none
Chen 2013	I: catgut embedding therapy	70	29 (13)	‐	‐	none	none
	C: lifestyle control	50	28 (13)	‐	‐	none	none
	all:	60	‐	‐	‐	none	none
Dang 2012	I1: electro‐acupuncture + lifestyle control	‐	32 (8)	‐	28 (2)	none	none
	I2: computerized intermediate‐frequency therapy + electro‐acupuncture + lifestyle control	‐	30 (10)	‐	27 (2)	none	none
	C: lifestyle control	‐	31 (10)	‐	28 (3)	none	none
	all:	69	‐	‐	‐	none	none
Ding 2013	I: acupuncture + lifestyle control	53	52 (8)	8 (2)	27 (3)	Glycaemic control (not specified)	Type 2 diabetes
	C: lifestyle control	53	53 (9)	7 (2)	27 (3)	Glycaemic control (not specified)	Type 2 diabetes
	all:	53	‐	‐	‐	Glycaemic control (not specified)	Type 2 diabetes
Duan 2013	I: acupuncture + lifestyle control	69	33 (8)	‐	28（4）	none	none
	C: foot holographic scraping therapy + lifestyle control	71	34 (7)	‐	29（4）	none	none
	all:	70	‐	‐	‐	none	none
Feng 2014	I: catgut embedding therapy + lifestyle control	71	31 (11)	‐	29 (2)	none	none
	C: lifestyle control	68	31 (8)	‐	29 (2)	none	none
	all:	70	‐	‐	‐	none	none
Gucel 2012	I: acupuncture	100	37 (8)	‐	33 (5)	none	none
	C: sham acupuncture	100	35 (6)	‐	34 (5)	none	none
	all:	100	‐	‐	‐	none	none
Guo 2011	I1: catgut embedding therapy + Chinese herbal medicine + lifestyle control	63	＜30 yrs 20% 30‐55 yrs 50% 56‐65 yrs 30%	‐	27 (2)	none	none
	I2: catgut embedding therapy + lifestyle control	67	＜30 yrs 13% 30‐55 yrs 53% 56‐65 yrs 33%	‐	27 (3)	none	none
	C: Chinese herbal medicine + lifestyle control	60	＜30 yrs 17% 30‐55 yrs 57% 56‐65 yrs 27%	‐	27 (3)	none	none
	all:	63	‐	‐	‐	none	none
He 2012	I: acupuncture	‐	‐	‐	‐	none	none
	C: flash‐fire cupping therapy	‐	‐	‐	‐	none	none
	all:	53	31 (6)	‐	‐	none	none
Hsu 2009	I: auricular acupuncture	100	40 (11)	‐	32 (4)	none	none
	C: sham auricular acupuncture	100	39 (14)	‐	31 (4)	none	none
	all:	100	40 (12)	‐	31 (4)	none	none
Hsu 2005a	I: electro‐acupuncture	100	42 (11)	‐	34 (3)	none	none
	C: sit‐up exercise	100	41 (10)	‐	33 (4)	none	none
	all:	100	‐	‐	‐	none	none
Hsu 2005b	I: electro‐acupuncture	100	40 (12)	‐	34 (3)	none	none
	C1: sit‐up exercise	100	41 (10)	‐	34 (3)	none	none
	C2: no intervention	100	41 (10)	‐	34 (3)	none	none
	all:	100	‐	‐	‐	none	none
Lai 2010	I: acupuncture	43	27 (3)	‐	29 (4)	Progesterone	PCOS
	C: western medicine	43	25 (5)	‐	29 (4)	Progesterone	PCOS
	all:	86	‐	‐	‐	Progesterone	PCOS
Li 2009	I: catgut embedding therapy	36	37	‐	‐	none	Hypertriglyceridemia
	C: western medicine	38	36	‐	‐	none	Hypertriglyceridemia
	all:	74	‐	‐	‐	none	Hypertriglyceridemia
Li 2014	I1: acupuncture	100	26 (2)	‐	29 (3)	none	PCOS
	I2: acupuncture + western medicine	100	27 (3)	‐	29 (3)	none	PCOS
	C: sham acupuncture + western medicine	100	25 (2)	‐	29 (2)	none	PCOS
	all:	100	‐	‐	‐	none	PCOS
Li L 2006	I1: electro‐acupuncture + lifestyle control	73	16 (2)	‐	29 (4)	none	none
	I2: electro‐auricular acupuncture + auricular acupressure + lifestyle control	69	15 (2)	‐	29 (4)	none	none
	C: lifestyle control	73	16 (2)	‐	29 (4)	none	none
	all:	72	‐	‐	‐	none	none
Lien 2012	I1: auricular acupuncture	100	39 (12)	‐	30 (2)	none	none
	I2: auricular acupressure	100	42 (12)	‐	30 (2)	none	none
	C: sham auricular acupuncture	100	41 (10)	‐	31 (4)	none	none
	all:	100	‐	‐	‐	none	none
Liu 2010	I1: catgut embedding therapy	100	27 (4)	‐	27 (2)	none	PCOS
	I2: catgut embedding therapy + Chinese herbal medicine	100	28 (4)	‐	27 (2)	none	PCOS
	C: Chinese herbal medicine	100	28 (3)	‐	28 (2)	none	PCOS
	all:	100	‐	‐	‐	none	PCOS
Liu 2011	I: electro‐acupuncture	77	33 (5)	‐	32 (4)	none	none
	C: low‐frequency electric stimulation therapy	77	30 (7)	‐	30 (4)	none	none
	all:	77	‐	‐	‐	none	none
Lu 2014	I: catgut embedding therapy + western medicine	100	27 (4)	‐	29 (1)	none	PCOS
	C: western medicine	100	25 (4)	‐	29 (2)	none	PCOS
	all:	100	‐	‐	‐	none	PCOS
Luo 2006	I1: electro‐acupuncture	‐	‐	‐	30 (5)	none	none
	I2: acupuncture	‐	‐	‐	30 (5)	none	none
	C: no intervention	‐	‐	‐	30 (5)	none	none
	all:	‐	21‐48	‐	‐	none	none
Mi 2005	I: acupuncture	‐	‐	‐	‐	none	none
	C: lifestyle control	‐	‐	‐	‐	none	none
	all:	91	38.4	‐	‐	none	none
Pan 2010	I: acupuncture + lifestyle control	79	36 (10)	‐	30 (3)	none	none
	C: sham acupuncture + lifestyle control	77	36 (9)	‐	31 (3)	none	none
	all:	78	‐	‐	‐	none	none
Rerksuppaphol 2011	I: electro‐acupuncture	22	33 (6)	‐	30 (4)	none	none
	C: transcutaneous electrical acupoint stimulation	23	34 (7)	‐	28 (3)	none	none
	all:	45	‐	‐	‐	none	none
Schukro 2014	I: electro‐auricular acupuncture	28	54	‐	34	none	none
	C: sham auricular acupuncture	28	50	‐	34	none	none
	all:	56	‐	‐	‐	none	none
Shan 2008	I: acupuncture + lifestyle control	96	19‐60	‐	‐	none	none
	C: lifestyle control	95	20‐58	‐	‐	none	none
	all:		‐	‐	‐	none	none
Shu 2011	I1: electro‐acupuncture + lifestyle control	100	‐	‐	28 (3)	none	none
	I2: auricular acupressure + lifestyle control	100	‐	‐	27 (3)	none	none
	C: moxibustion + lifestyle control	100	‐	‐	28 (3)	none	none
	all:	100	20‐26	‐	‐	none	none
Su 2013	I: acupuncture + Chinese herbal medicine + lifestyle control	100	26 (5)	‐	29 (3)	none	PCOS
	C: Chinese herbal medicine + lifestyle control	100	28 (5)	‐	29 (4)	none	PCOS
	all:	100	‐	‐	‐	none	PCOS
Tao 2009	I: catgut embedding therapy + Chinese herbal medicine	100	24 (5)	‐	28 (2)	none	PCOS
	C: Chinese herbal medicine	100	25 (4)	‐	27 (2)	none	PCOS
	all:	100	‐	‐	‐	none	PCOS
Tao 2010	I1: catgut embedding therapy + Chinese herbal medicine	100	‐	‐	27 (2)	none	PCOS
	I2: catgut embedding therapy	100	‐	‐	27 (2)	none	PCOS
	C: Chinese herbal medicine	100	‐	‐	28 (2)	none	PCOS
	all:	100	‐	‐		none	PCOS
Tong 2011	I: acupuncture + lifestyle control	76	35 (9)	‐	30 (3)	none	none
	C: sham acupuncture + lifestyle control	71	35 (9)	‐	31 (3)	none	none
	all:	75	‐	‐	‐	none	none
Wang 2014	I: acupuncture + lifestyle control	80	36 (8)	‐	28 (1)	none	none
	C: Chinese herbal medicine + lifestyle control	70	37 (8)	‐	28 (1)	none	none
	all:	75	‐	‐	‐	none	none
Wang X 2006	I1: electro‐acupuncture	‐	‐	‐	27	none	none
	I2: electro‐acupuncture + Chinese herbal medicine	‐	‐	‐	28	none	none
	C: Chinese herbal medicine	‐	37	‐	28	none	none
	all:	92	20‐29 yrs 30% 30‐39 yrs 30% 40‐49 yrs 22% 50‐59 yrs 18%	‐	‐	none	none
Wu 2009	I: catgut embedding therapy + lifestyle control	60	‐	‐	27 (2)	none	none
	C: western medicine + lifestyle control	53	‐	‐	24 (2)	none	none
	all:	57	32	‐	‐	none	none
Xing 2009	I: acupuncture + lifestyle control	87	28 (7)	‐	28 (2)	none	none
	C: lifestyle control	90	28 (7)	‐	28 (1)	none	none
	all:	89	‐	‐	‐	none	none
Xiong 2011	I: acupuncture	‐	‐	‐	‐	none	none
	C1: needle‐knife	‐	‐	‐	‐	none	none
	C2: western medicine	‐	‐	‐	‐	none	none
	all:	‐	‐	‐	‐	none	none
Xu 2008	I: catgut embedding therapy + lifestyle control	83	36 (14)	‐	28 (1)	none	none
	C: Chinese herbal medicine + lifestyle control	67	36 (12)	‐	28 (1)	none	none
	all:	75	‐	‐	‐	none	none
Xu 2011	I: acupuncture	76	42 (12)	‐	33 (4)	none	Type 2 diabetes
	C: western medicine	74	43 (13)	‐	32 (4)	none	Type 2 diabetes
	all:	75	‐	‐	‐	none	Type 2 diabetes
Yan 2011	I: acupuncture + lifestyle control	60	18‐60	‐	‐	none	none
	C: bian‐stone + lifestyle control	63	19‐58	‐	‐	none	none
	all:	61	‐	‐	‐	none	none
Ye 2010	I: electro‐acupuncture + lifestyle control	58	＜20 yrs 17% 21‐40 yrs 63% ＞41 yrs 21%	‐	‐	none	none
	C: lifestyle control	56	＜20 yrs 15% 21‐40 yrs 58% ＞41 yrs 27%	‐	‐	none	none
	all:	57	‐	‐	‐	none	none
Yin 2006	I: acupuncture	50	37 (11)	‐	26 (7)	none	none
	C: acupoint plaster application	58	38 (11)	‐	26 (6)	none	none
	all:	108		‐	‐	none	none
Zhang 2005	I: acupuncture	87	‐	‐	28 (3)	none	none
	C: magnet plastering therapy	90	‐	‐	27 (3)	none	none
	all:	88	‐	‐	‐	none	none
Zhang 2011	I1: electro‐acupuncture + lifestyle control	‐	35 (10)	‐	28 (2)	none	none
	I2: electro‐acupuncture + computerized intermediate‐frequency + lifestyle control	‐	28 (12)	‐	27 (2)	none	none
	C: lifestyle control	‐	30 (9)	‐	28 (3)	none	none
	all:	77	‐	‐	‐	none	none
Zhang 2012	I: electro‐acupuncture	‐	‐	‐	28 (4)	none	none
	C: sham acupuncture	‐	‐	‐	27 (6)	none	none
	all:	50	34 (6)	‐	‐	none	none
Zhang Y 2007	I: electro‐acupuncture + lifestyle control	63	33 (4)	‐	‐	none	none
	C: lifestyle control	69	33 (4)	‐	‐	none	none
	all:	66	‐	‐	‐	none	none
Zhao 2010	I: electro‐acupuncture + lifestyle control	84	29 (9)	‐	29 (4)	none	none
	C: lifestyle control	80	30 (10)	‐	28 (4)	none	none
	all:	82	‐	‐	‐	none	none
Zhao 2011	I: electro‐acupuncture + transcutaneous electrical acupoint stimulation	‐	‐	‐	29 (3)	none	none
	C: sham acupuncture + transcutaneous electrical acupoint stimulation	‐	‐	‐	28 (2)	none	none
	all:	97	29	‐	‐	none	none
Zhu 2007	I1: acupuncture+ auricular acupuncture + lifestyle control	86	38 (6)	‐	‐	none	none
	I2: acupuncture+ auricular acupuncture	90	37 (6)	‐	‐	none	none
	C: lifestyle control	89	37 (6)	‐	‐	none	none
	all:	88	‐	‐	‐	none	none
"‐" denotes not reported BMI: body mass index; C: comparator; HbA1c: glycosylated haemoglobin A1c; I: intervention; SD: standard deviation; PCOS: polycystic ovarian syndrome

	Endpoints quoted in trial document (s) (e.g. ClinicalTrials.gov ID: NCT... FDA/EMA document manufacturer's website published design paper)^a	Time points of measurement in trial document (s) [e.g. mo/yr/wk]	Endpoints quoted in publication (s)^b	Time points of measurement in publication (s) [e.g. mo/yr/wk]
Chen 2009	N/T	N/A	Primary outcome measure (s): ‐	‐
	N/T	N/A	Secondary outcome measure (s): FINS	3 wks
	N/T	N/A	Other outcome measure (s): (1) effective rate (2) leptin	3 wks
	N/T	N/A	Reported subgroups: ‐	‐
Chen 2013	N/T	N/A	Primary outcome measure (s): ‐	‐
	N/T	N/A	Secondary outcome measure (s): ‐	‐
	N/T	N/A	Other outcome measure (s): effective rate	8 wks
	N/T	N/A	Reported subgroups: ‐	‐
Dang 2012	N/T	N/A	Primary outcome measure (s): (1) body weight (2) adverse effect	10 wks
	N/T	N/A	Secondary outcome measure (s): (1) BMI (2) body fat percentage	10 wks
	N/T	N/A	Other outcome measure (s): effective rate	10 wks
	N/T	N/A	Reported subgroups: ‐	‐
Ding 2013	N/T	N/A	Primary outcome measure (s): ‐	‐
	N/T	N/A	Secondary outcome measure (s): (1) BMI (2) FPG (3) 2hPG (4) HbA₁C (5) Homa‐IR	1 yr
	N/T	N/A	Other outcome measure (s): (1) leptin (2) adiponectin	1 yr
	N/T	N/A	Reported subgroups: ‐	‐
Duan 2013	N/T	N/A	Primary outcome measure (s): (1) body weight (2) adverse effect	I: 4 wks C: 5 wks
	N/T	N/A	Secondary outcome measure (s): (1) BMI (2) WC (3) HC	I: 4 wks C: 5 wks
	N/T	N/A	Other outcome measure (s): effective rate	‐
	N/T	N/A	Reported subgroups: ‐	‐
Feng 2014	N/T	N/A	Primary outcome measure (s): body weight	4 wks
	N/T	N/A	Secondary outcome measure (s): (1) BMI (2) WC (3) HC (4) WHR	4 wks
	N/T	N/A	Other outcome measure (s): effective rate	4 wks
	N/T	N/A	Reported subgroups: ‐	‐
Gucel 2012	N/T	N/A	Primary outcome measure (s): body weight	5 wks
	N/T	N/A	Secondary outcome measure (s): (1) BMI (2) FINS	5 wks
	N/T	N/A	Other outcome measure (s): (1) leptin (2) ghrelin (3) cholecystokinin	5 wks
	N/T	N/A	Reported subgroups: ‐	‐
Guo 2011	N/T	N/A	Primary outcome measure (s): (1) body weight (2) adverse effect	6 wks
	N/T	N/A	Secondary outcome measure (s): (1) BMI (2) WC (3) HC (4) TC (5) TG (6) HDL‐C (7) LDL‐C (8) FBG	6 wks
	N/T	N/A	Other outcome measure (s): effective rate	6 wks
	N/T	N/A	Reported subgroups: ‐	‐
He 2012	N/T	N/A	Primary outcome measure (s): ‐	5 wks
	N/T	N/A	Secondary outcome measure (s): ‐	‐
	N/T	N/A	Other outcome measure (s): effective rate	5 wks
	N/T	N/A	Reported subgroups: ‐	‐
Hsu 2009	N/T	N/A	Primary outcome measure (s): (1) body weight (2) adverse effect	6 wks
	N/T	N/A	Secondary outcome measure (s): (1) BMI (2) WC (3) HC (4) TC (5) TG (6) HDL‐C (7) LDL‐C (8) FPG (9) Homa‐IR	6 wks
	N/T	N/A	Other outcome measure (s): (1) leptin (2) adiponectin (3) ghrelin	6 wks
	N/T	N/A	Reported subgroups: ‐	‐
Hsu 2005a	N/T	N/A	Primary outcome measure (s): (1) body weight (2) adverse effect	6 wks; 13 wks
	N/T	N/A	Secondary outcome measure (s): (1) BMI (2) WC	6 wks; 13 wks
	N/T	N/A	Other outcome measure (s): ‐	‐
	N/T	N/A	Reported subgroups: ‐	‐
Hsu 2005b	N/T	N/A	Primary outcome measure (s): (1) body weight (2) adverse effect	6 wks
	N/T	N/A	Secondary outcome measure (s): (1) BMI (2) WC (3) HC (4) WHR (5) TC (6) TG (7) FBG	6 wks
	N/T	N/A	Other outcome measure (s): ‐	‐
	N/T	N/A	Reported subgroups: ‐	‐
Lai 2010	N/T	N/A	Primary outcome measure (s): adverse effect	24 wks
	N/T	N/A	Secondary outcome measure (s): (1) BMI (2) WHR (3) body fat percentage (4) TC (5) TG (6) HDL‐C (7) LDL‐C (8) FBG (9) 2hPG (10) FINS (11) 2hINS (12) Homa‐IR	24 wks
	N/T	N/A	Other outcome measure (s): (1) FSH (2) LH (3) T	24 wks
	N/T	N/A	Reported subgroups: ‐	‐
Li 2009	N/T	N/A	Primary outcome measure (s): body weight	8 wks
	N/T	N/A	Secondary outcome measure (s): (1) TC (2) TG (3) HDL‐C (4) LDL‐C (5) Lpa	8 wks
	N/T	N/A	Other outcome measure (s): ‐	‐
	N/T	N/A	Reported subgroups: ‐	‐
Li 2014	N/T	N/A	Primary outcome measure (s): adverse effect	24 wks
	N/T	N/A	Secondary outcome measure (s): (1) BMI (2) WHR (3) TC (4) TG (5) HDL‐C (6) LDL‐C (7) FPG (8) FINS (9) Homa‐IR	24 wks
	N/T	N/A	Other outcome measure (s): (1) FSH (2) LH (3) LH/FSH (4) T	24 wks
	N/T	N/A	Reported subgroups: ‐	‐
Li L 2006	N/T	N/A	Primary outcome measure (s): body weight	70 days; 100 days
	N/T	N/A	Secondary outcome measure (s): (1) BMI (2) TC (3) TG (4) HDL‐C (5) LDL‐C	70 days; 100 days
	N/T	N/A	Other outcome measure (s): effective rate	70 days; 100 days
	N/T	N/A	Reported subgroups: ‐	‐
Lien 2012	N/T	N/A	Primary outcome measure (s): (1) body weight (2) adverse effect	4 wks
	N/T	N/A	Secondary outcome measure (s): (1) BMI (2) WC (3) HC (4) WHR (5) QOL (6) TC (7) TG (8) HDL‐C (9) LDL‐C (10) FINS (11) Homa‐IR	4 wks
	N/T	N/A	Other outcome measure (s): (1) leptin (2) adiponectin (3) ghrelin	4 wks
	N/T	N/A	Reported subgroups: ‐	‐
Liu 2010	N/T	N/A	Primary outcome measure (s): ‐	‐
	N/T	N/A	Secondary outcome measure (s): BMI	24 wks
	N/T	N/A	Other outcome measure (s): (1) T (2) SHBG (3) A2	24 wks
	N/T	N/A	Reported subgroups: ‐	‐
Liu 2011	N/T	N/A	Primary outcome measure (s): (1) body weight (2) adverse effect	8 wks
	N/T	N/A	Secondary outcome measure (s): (1) BMI (2) WC (3) HC (4) WHR	8 wks
	N/T	N/A	Other outcome measure (s): (1) effective rate (2) accompanied symptoms	8 wks
	N/T	N/A	Reported subgroups: ‐	‐
Lu 2014	N/T	N/A	Primary outcome measure (s): ‐	‐
	N/T	N/A	Secondary outcome measure (s): (1) BMI (2) WHR (3) body fat percentage	12 wks
	N/T	N/A	Other outcome measure (s): (1) FSH (2) LH (3) E₂ (4) T	12 wks
	N/T	N/A	Reported subgroups: ‐	‐
Luo 2006	N/T	N/A	Primary outcome measure (s): (1) adverse effect	3 courses (days unclear)
	N/T	N/A	Secondary outcome measure (s): (1) BMI (2) WHR (3) TC (4) TG (5) HDL‐C (6) LDL‐C	3 courses (days unclear)
	N/T	N/A	Other outcome measure (s): (1) effective rate (2) leptin (3) adiponectin	3 courses (days unclear)
	N/T	N/A	Reported subgroups: ‐	‐
Mi 2005	N/T	N/A	Primary outcome measure (s): ‐	‐
	N/T	N/A	Secondary outcome measure (s): ‐	‐
	N/T	N/A	Other outcome measure (s): effective rate	12 wks
	N/T	N/A	Reported subgroups: ‐	‐
Pan 2010	N/T	N/A	Primary outcome measure (s): ‐	‐
	N/T	N/A	Secondary outcome measure (s): BMI	12 wks
	N/T	N/A	Other outcome measure (s): (1) visual analogue scale (2) gastric fluid survival rate	12 wks
	N/T	N/A	Reported subgroups: ‐	‐
Rerksuppaphol 2011	N/T	N/A	Primary outcome measure (s): (1) body weight (2) adverse effect	2 wks; 4 wks; 6 wks; 8 wks
	N/T	N/A	Secondary outcome measure (s): (1) BMI (2) WC (3) HC (4) WHR	2 wks; 4 wks; 6 wks; 8 wks
	N/T	N/A	Other outcome measure (s): ‐	‐
	N/T	N/A	Reported subgroups: ‐	‐
Schukro 2014	N/T	N/A	Primary outcome measure (s): (1) body weight (2) adverse effect	6 wks; 10 wks
	N/T	N/A	Secondary outcome measure (s): (1) BMI (2) body fat percentage	6 wks; 10 wks
	N/T	N/A	Other outcome measure (s): ‐	‐
	N/T	N/A	Reported subgroups: ‐	‐
Shan 2008	N/T	N/A	Primary outcome measure (s): ‐	‐
	N/T	N/A	Secondary outcome measure (s): ‐	‐
	N/T	N/A	Other outcome measure (s): effective rate	6 wks; 10 wks
	N/T	N/A	Reported subgroups: ‐	‐
Shu 2011	N/T	N/A	Primary outcome measure (s): body weight	3 wks; 6 wks
	N/T	N/A	Secondary outcome measure (s): (1) BMI (2) WC (3) HC (4) body fat percentage (5) TC (6) TG	3 wks; 6 wks
	N/T	N/A	Other outcome measure (s): effective rate	‐
	N/T	N/A	Reported subgroups: ‐	‐
Su 2013	N/T	N/A	Primary outcome measure (s): ‐	‐
	N/T	N/A	Secondary outcome measure (s): (1) BMI (2) FPG (3) FINS (4) Homa‐IR	12 wks
	N/T	N/A	Other outcome measure (s): (1) FSH (2) LH (3) LH/FSH (4) T	12 wks
	N/T	N/A	Reported subgroups: ‐	‐
Tao 2009	N/T	N/A	Primary outcome measure (s): ‐	‐
	N/T	N/A	Secondary outcome measure (s): (1) BMI (2) FPG (3) FINS (4) Homa‐IR	12 wks
	N/T	N/A	Other outcome measure (s): (1) leptin (2) TNF‐α	12 wks
	N/T	N/A	Reported subgroups: ‐	‐
Tao 2010	N/T	N/A	Primary outcome measure (s): ‐	‐
	N/T	N/A	Secondary outcome measure (s): (1) BMI (2) WC (3) TC (4) TG (5) HDL‐C (6) LDL‐C (7) FPG (8) FINS (9) Homa‐IR	12 wks
	N/T	N/A	Other outcome measure (s): ‐	‐
	N/T	N/A	Reported subgroups: ‐	‐
Tong 2011	N/T	N/A	Primary outcome measure (s): ‐	‐
	N/T	N/A	Secondary outcome measure (s): (1) BMI (2) TC (3) TG (4) glucose	5 wks
	N/T	N/A	Other outcome measure (s): (1) visual analogue scale (2) uric acid	5 wks
	N/T	N/A	Reported subgroups: ‐	‐
Wang 2014	N/T	N/A	Primary outcome measure (s): ‐	‐
	N/T	N/A	Secondary outcome measure (s): (1) BMI (2) body fat percentage	‐
	N/T	N/A	Other outcome measure (s): effective rate	12 wks
	N/T	N/A	Reported subgroups: ‐	‐
Wang X 2006	N/T	N/A	Primary outcome measure (s): body weight	6 wks
	N/T	N/A	Secondary outcome measure (s): (1) BMI (2) WC (3) HC (4) BC (5) body fat percentage (6) TC (7) TG (8) HDL‐C	6 wks
	N/T	N/A	Other outcome measure (s): (1) glucose (2) T₄	6 wks
	N/T	N/A	Reported subgroups: ‐	‐
Wu 2009	N/T	N/A	Primary outcome measure (s): (1) body weight (2) adverse effect	4 wks
	N/T	N/A	Secondary outcome measure (s): (1) BMI (2) WHR (3) TC (4) TG (5) HDL‐C (6) LDL‐C (7) FPG (8) FINS (9) Homa‐IR	4 wks
	N/T	N/A	Other outcome measure (s): effective rate	4 wks
	N/T	N/A	Reported subgroups: ‐	‐
Xing 2009	N/T	N/A	Primary outcome measure (s): body weight	51 days
	N/T	N/A	Secondary outcome measure (s): (1) BMI (2) WHR (3) TC (4) TG (5) HDL‐C (6) LDL‐C	51 days
	N/T	N/A	Other outcome measure (s): (1) effective rate (2) leptin	51 days
	N/T	N/A	Reported subgroups: ‐	‐
Xiong 2011	N/T	N/A	Primary outcome measure (s): ‐	‐
	N/T	N/A	Secondary outcome measure (s): FINS	8 wks
	N/T	N/A	Other outcome measure (s): (1) effective rate (2) leptin	8 wks
	N/T	N/A	Reported subgroups: ‐	‐
Xu 2008	N/T	N/A	Primary outcome measure (s): body weight	8 wks
	N/T	N/A	Secondary outcome measure (s): (1) BMI (2) WC (3) HC (4) body fat percentage	8 wks
	N/T	N/A	Other outcome measure (s): ‐	‐
	N/T	N/A	Reported subgroups: ‐	‐
Xu 2011	N/T	N/A	Primary outcome measure (s): ‐	‐
	N/T	N/A	Secondary outcome measure (s): (1) BMI (2) FPG (3) FINS	9 wks
	N/T	N/A	Other outcome measure (s): (1) Leptin (2) Adiponectin	9 wks
	N/T	N/A	Reported subgroups: ‐	‐
Yan 2011	N/T	N/A	Primary outcome measure (s): ‐	‐
	N/T	N/A	Secondary outcome measure (s): WC	6 wks
	N/T	N/A	Other outcome measure (s): effective rate	6 wks
	N/T	N/A	Reported subgroups: ‐	‐
Ye 2010	N/T	N/A	Primary outcome measure (s): ‐	‐
	N/T	N/A	Secondary outcome measure (s): ‐	‐
	N/T	N/A	Other outcome measure (s): effective rate	12 wks
	N/T	N/A	Reported subgroups: ‐	‐
Yin 2006	N/T	N/A	Primary outcome measure (s): (1) body weight (2) adverse effect	12 wks
	N/T	N/A	Secondary outcome measure (s): (1) BMI (2) WC (3) HC (4) WHR (5) TC (6) TG (7) LDL‐C (8) glucose	12 wks
	N/T	N/A	Other outcome measure (s): effective rate	‐
	N/T	N/A	Reported subgroups: ‐	‐
Zhang 2005	N/T	N/A	Primary outcome measure (s): (1) body weight (2) BMI	4 wks
	N/T	N/A	Secondary outcome measure (s): (1) BMI (2) WC (3) HC (4) WHR (5) body fat percentage (6) TC (7) TG (8) HDL‐C (9) LDL‐C (10) glucose	4 wks
	N/T	N/A	Other outcome measure (s): (1) leptin (2) NPY	4 wks
	N/T	N/A	Reported subgroups: ‐	‐
Zhang 2011	N/T	N/A	Primary outcome measure (s): body weight	8 wks
	N/T	N/A	Secondary outcome measure (s): (1) BMI (2) body fat percentage	8 wks
	N/T	N/A	Other outcome measure (s): effective rate	8 wks
	N/T	N/A	Reported subgroups: ‐	‐
Zhang 2012	N/T	N/A	Primary outcome measure (s): (1) BMI (2) adverse effect	4 wks
	N/T	N/A	Secondary outcome measure (s): (1) WHR (2) body fat percentage	4 wks
	N/T	N/A	Other outcome measure (s): ‐	‐
	N/T	N/A	Reported subgroups: ‐	‐
Zhang Y 2007	N/T	N/A	Primary outcome measure (s): ‐	‐
	N/T	N/A	Secondary outcome measure (s): ‐	‐
	N/T	N/A	Other outcome measure (s): (1) effective rate (2) patient satisfaction	8 wks
	N/T	N/A	Reported subgroups: ‐	‐
Zhao 2010	N/T	N/A	Primary outcome measure (s): body weight	8 wks
	N/T	N/A	Secondary outcome measure (s): (1) BMI (2) WC (3) FBG (4) 2hPG (5) FINS (6) 2hFINS	8 wks
	N/T	N/A	Other outcome measure (s): effective rate	8 wks
	N/T	N/A	Reported subgroups: ‐	‐
Zhao 2011	N/T	N/A	(Primary outcome measure (s): body weight	4 wks
	N/T	N/A	Secondary outcome measure (s): BMI	‐
	N/T	N/A	Other outcome measure (s): effective rate	4 wks
	N/T	N/A	Reported subgroups: ‐	‐
Zhu 2007	N/T	N/A	Primary outcome measure (s): ‐	12 wks
	N/T	N/A	Secondary outcome measure (s): (1) BMI (2) AC	12 wks
	N/T	N/A	Other outcome measure (s): effective rate	12 wks
	N/T	N/A	Reported subgroups: ‐	‐
"‐" denotes not reported ^aTrial document (s) refers to all available information from published design papers and sources other than regular publications (e.g. FDA/EMA documents, manufacturer's websites, trial registers) ^bPublication (s) refers to all published trial information (primary reference, duplicate publications, companion documents or multiple reports of a primary study) EMA: European Medicines Agency; FDA: Food and Drug Administration (US); mo: month (s); N/A: not applicable; N/T: no trial document available; yr: year (s); wk: week (s) 2hPG: 2‐hour plasma glucose; BMI: body mass index; FPG: fasting plasma glucose; FINS: fasting insulin; HbA1c: glycosylated haemoglobin A1c; HC: hip circumference; HDL‐C: high‐density lipoprotein cholesterol; Homa‐IR: homeostasis model assessment of insulin resistance; LDL‐C: low‐density lipoprotein cholesterol; TC: total cholesterol; TG: triglyceride; QOL: quality of life; WC: waist circumference; WHR: waist hip ratio

	Outcome	High risk of bias (category A)^a	High risk of bias (category D)^b	High risk of bias (category E)^c	High risk of bias (category G)^d
Ding 2013	BMI, FPG, 2hPG, HbA1c, Homa‐IR, leptin and adiponectin				x
Hsu 2005a	body weight, BMI, adverse effect and WC				x
Liu 2010	BMI, T, SHBG and A2				x
Shu 2011	body weight, BMI, effective rate, WC, HC, TC, TG and body fat percentage				x
Su 2013	BMI, FPG, FINS and Homa‐IR, FSH, LH, LH/FSH and T				x
Wang 2014	BMI, effective rate and body fat percentage				x
Wu 2009	Body weight, BMI, effective rate, adverse effect, WHR, TC, TG, HDL‐C, LDL‐C, FPG, FINS and Homa‐IR				x
Zhang 2011	Body weight, BMI, effective rate and body fat percentage				x
Zhao 2011	Body weight, BMI and effective rate				x
^aClear that outcome was measured and analysed; trial report states that outcome was analysed but only reports that result was not significant (Classification 'A', table 2, Kirkham 2010) ^bClear that outcome was measured and analysed; trial report states that outcome was analysed but no results reported ( Classification 'D', table 2, Kirkham 2010) ^cClear that outcome was measured; clear that outcome was measured but not necessarily analysed; judgement says likely to have been analysed but not reported because of non‐significant results (Classification 'E', table 2, Kirkham 2010) ^dUnclear whether the outcome was measured; not mentioned but clinical judgement says likely to have been measured and analysed but not reported on the basis of non‐significant results (Classification 'G', table 2, Kirkham 2010) 2hPG: 2‐hour plasma glucose; A2: androstenedione; BMI: body mass index; FPG: fasting plasma glucose; FINS: fasting insulin; FSH: follicle stimulating hormone; HbA1c: glycosylated haemoglobin A1c; HDL‐C: high‐density lipoprotein cholesterol; Homa‐IR: homeostasis model assessment of insulin resistance; LDL‐C: low‐density lipoprotein cholesterol; LH: luteinizing hormone; SHBG: sex hormone binding globulin; T: testoserone; TC: total cholesterol; TG: triglyceride; WHR: waist hip ratio

	Weight loss^a	Anthropometric measures other than weight loss^a	Morbidity	Health‐related quality of life	Physical activity^a	Socioeconomic effects	Severe / serious adverse events
Chen 2009	N/D	N/I	N/I	N/I	N/I	N/I	N/I
Chen 2013	N/D	N/I	N/I	N/I	N/I	N/I	N/I
Dang 2012	"BMI, body weight and F% were measured by Omron Fat Loss Monitor HBF‐351. Before taking a measurement personal data must be entered. Stand with both feet slightly apart. Place both hands on the monitor by holding the grip electrodes. Hold the electrodes with both hands. The monitor automatically starts the measurement."	"BMI, body weight and F% were measured by Omron Fat Loss Monitor HBF‐351.Before taking a measurement personal data must be entered. Stand with both feet slightly apart. Place both hands on the monitor by holding the grip electrodes. Hold the electrodes with both hands. The monitor automatically starts the measurement."	N/I	N/I	N/I	N/I	No
Ding 2013	BMI = body weight/height (kg/m²).	"One person was responsible for measuring height, body weight, WC, HC."	N/I	N/I	N/I	N/I	N/I
Duan 2013	"Body weight was measured by the same weighing scale. Participants were measured without shoes or heavy outer clothing and measured to the nearest 10 g."	"Height was measured by the same weighing scale. Participants were measured without shoes or heavy outer clothing and measured to the nearest 10 g." "WC and HC was measured by a tape measure after breathing out normally. The waist was measured around the bare abdomen. The hip was measured at its widest portion of the buttocks."	N/I	N/I	N/I	N/I	No
Feng 2014	N/D	"The hip was measured around the midpoint between 12th rib and anterior superior spine. WHR = WC/HC"	N/I	N/I	N/I	N/I	N/I
Gucel 2012	N/D	N/I	N/I	N/I	N/I	N/I	N/I
Guo 2011	N/D	"Participants were measured without shoes or heavy outer clothing and measured to the nearest 10 g." "WC and HC was measured by a tape measure after breathing out normally. The waist was measured around the 12th rib. The hip was measured at its widest portion of the buttocks."	N/I	N/I	N/I	N/I	No
He 2012	N/D	N/I	N/I	N/I	N/I	N/I	N/I
Hsu 2009	"The anthropometric measures are described in our previous studies."	"The anthropometric measures are described in our previous studies."	N/I	N/I	N/I	N/I	No
Hsu 2005a	"All measurements were carried out after an overnight fast using standardized methods and were performed in the beginning, 6, 8 and 13 weeks later. Height was measured with a wall‐mounted stadiometer to the nearest 0.1 cm, weight was measured on a calibrated balance beam scale to the nearest 0.1 kg, and BMI was calculated (BMI = body weight (BW)/height (kg/m²))."	"WC was measured mid‐way between the lateral lower rib margin and the iliac crest, hip circumference (HC) was measured at the levels of the major trochanters through the pubic symphysis, with the scale to the nearest 0.1 cm, and WC/HC ratio (WHR) was calculated (WHR = WC/HC). All subjects were measured in the undergarments with a hospital gown on. "	N/I	N/I	N/I	N/I	N/I
Hsu 2005b	"The participants were measured in their undergarments and a hospital gown. Height was measured with a wallmounted stadiometer to the nearest 0.1 cm. Weight was measured on a calibrated balance beam scale to the nearest 0.1 kg, and BMI was calculated as body weight (BW)/height (kg/m²)). "	"WC was measured midway between the lateral lower rib margin and the iliac crest. Hip circumference (HC) was measured at the levels of the major trochanters through the pubic symphysis, with the scale to the nearest 0.1 cm. The ratio of WC/HC was calculated as waist/hip ratio (WHR)."	N/I	N/I	N/I	N/I	No
Lai 2010	"BMI = body weight/height (kg/m²)."	N/D	N/I	N/I	N/I	N/I	N/I
Li 2009	"Body weight was measured in the same conditions, e.g., time, clothing, measuring instrument, etc. One physician was responsible for measuring."	N/I	N/I	N/I	N/I	N/I	N/I
Li 2014	"BMI = body weight/height (kg/m²)."	"Physician was responsible for recording medical history. The waist was measured around the 12th rib. The hip was measured at its widest portion of the buttocks."	N/I	N/I	N/I	N/I	No
Li L 2006	Does not say how body weight was measured.	N/I	N/I	N/I	N/I	N/I	N/I
Lien 2012	"All measurements were made after 8–9 hour of fasting using a standardized method, as detailed in our previous research, at the beginning and the end of the study. Parameters of physical parameters were measured once a week to identify any changes."	"Parameters of physical parameters were measured once a week to identify any changes."	N/I	"To measure the quality of life among our subjects, we used the self‐administered questionnaire of WHOQoL‐BREF, Taiwan version, which was well validated with consistency coefficients ranging from 0.70 to 0.77. The WHOQoL‐BREF questionnaire evaluated quality of life in physical, psychological, social and environmental domains, with scores ranging from 0 to 100. Subjects were asked to complete the questionnaire before the start and at the end of the study."	N/I	N/I	No
Liu 2010	Does not say how body weight was measured.	N/I	N/I	N/I	N/I	N/I	N/I
Liu 2011	"All measurements were measured with a standard method. Body weight and BMI were measured in the same conditions, e.g., time, clothing, measuring instrument, etc. BMI = body weight/height (kg/m²)"	"The waist was measured around the 12th rib. The hip was measured at its widest portion of the buttocks."	N/I	N/I	N/I	N/I	N/I
Lu 2014	N/D	N/D	N/I	N/I	N/I	N/I	N/I
Luo 2006	N/D	N/D	N/I	N/I	N/I	N/I	N/I
Mi 2005	N/D	N/I	N/I	N/I	N/I	N/I	N/I
Pan 2010	"The participants were measured on an empty stomach or after defecation. BMI = body weight/height (kg/m²)."	N/I	N/I	N/I	N/I	N/I	N/I
Rerksuppaphol 2011	"Weight was measured to the nearest 0.1 kg using an electronic scale (Tanita®, BF‐680W, Tokyo, Japan)." "The body mass index was calculated as the ratio of weight/ (height) ² [kg/m²]" "All measurements were carried out by trained staff."	"Height, waist and hip circumferences were measured by tape to the nearest 0.1 cm." "Waist circumference was measured at the midpoint between the lower costal margin and the top of the iliac crest while the subject was in a standing position. Hip circumference was measured in the standing position at the maximum circumference over the buttocks." "All measurements were carried out by trained staff."	N/I	N/I	N/I	N/I	"Any adverse events during the treatment were recorded."
Schukro 2014	N/D	N/I	N/I	N/I	N/I	N/I	N/I
Shan 2008	N/D	N/I	N/I	N/I	N/I	N/I	N/I
Shu 2011	"Body weight was measured at 10 am. BMI = body weight/height (kg/m²)."	"Waist circumference was measured at the midpoint between the lower costal margin and the top of the iliac crest while the subject was in a standing position. Hip circumference was measured in the standing position at the maximum circumference over the buttocks. WHR = WC/HC."	N/I	N/I	N/I	N/I	N/I
Su 2013	"BMI = body weight/height (kg/m²)."	N/I	N/I	N/I	N/I	N/I	N/I
Tao 2009	N/D	N/I	N/I	N/I	N/I	N/I	N/I
Tao 2010	N/D	N/D	N/I	N/I	N/I	N/I	N/I
Tong 2011	N/D	N/I	N/I	N/I	N/I	N/I	N/I
Wang 2014	N/D	N/I	N/I	N/I	N/I	N/I	N/I
Wang X 2006	"All measurements were measured with a standard method. Body weight and BMI were measured in the same conditions, e.g., time, clothing, measuring instrument, etc."	"All measurements were measured with a standard method. Body weight and BMI were measured in the same conditions, e.g., time, clothing, measuring instrument, etc."	N/I	N/I	N/I	N/I	N/I
Wu 2009	"Body weight was measured with a standard method. Body weight and BMI were measured in the same conditions, e.g., time, clothing, measuring instrument, etc. BMI = body weight/height (kg/m²)."	"Waist circumference should be measured at the midpoint between the lower margin of the least palpable rib and the top of the iliac crest, using a stretch resistant tape that provides a constant 100 g tension. Hip circumference should be measured around the widest portion of the buttocks, with the tape parallel to the floor. WHR = WC/HC."	N/I	N/I	N/I	N/I	N/I
Xing 2009	"Body weight was measured with a standard method. Body weight and BMI were measured in the same conditions, e.g., time, clothing, measuring instrument, etc. BMI = body weight/height (kg/m²)."	"Waist circumference should be measured at the midpoint between the lower margin of the least palpable rib and the top of the iliac crest, using a stretch resistant tape that provides a constant 100 g tension. Hip circumference should be measured around the widest portion of the buttocks, with the tape parallel to the floor. WHR = WC/HC."	N/I	N/I	N/I	N/I	N/I
Xiong 2011	N/D	N/I	N/I	N/I	N/I	N/I	N/I
Xu 2008	"Body weight was measured with a standard method. Body weight and BMI were measured in the same conditions, e.g., time, clothing, measuring instrument, etc. BMI = body weight/height (kg/m²)."	"Waist circumference was measured at the midpoint between the lower costal margin and the top of the iliac crest while the subject was in a standing position. Hip circumference was measured around the widest portion of the buttocks, with the tape parallel to the floor. "	N/I	N/I	N/I	N/I	N/I
Xu 2011	N/D	N/I	N/I	N/I	N/I	N/I	N/I
Yan 2011	N/D	N/D	N/I	N/I	N/I	N/I	N/I
Ye 2010	N/D	N/I	N/I	N/I	N/I	N/I	N/I
Yin 2006	"Body weight was measured with a standard method. Body weight and BMI were measured in the same conditions, e.g., time, clothing, measuring instrument, etc."	"Waist circumference was measured at the midpoint between the lower costal margin and the top of the iliac crest while the subject was in a standing position. Hip circumference was measured around the widest portion of the buttocks, with the tape parallel to the floor. "	N/I	N/I	N/I	N/I	N/I
Zhang 2005	"Body weight was measured with a standard method. Body weight and BMI were measured in the same conditions, e.g., time, clothing, measuring instrument, etc. BMI = body weight/height (kg/m²)."	"Waist circumference was measured at the midpoint between the lower costal margin and the top of the iliac crest while the subject was in a standing position. Hip circumference was measured around the widest portion of the buttocks, with the tape parallel to the floor. WHR = WC/HC."	N/I	N/I	N/I	N/I	N/I
Zhang 2011	"BMI, body weight and F% were measured by Omron Fat Loss Monitor HBF‐351.Before taking a measurement personal data must be entered. Stand with both feet slightly apart. Place both hands on the monitor by holding the grip electrodes. Hold the electrodes with both hands. The monitor automatically starts the measurement."	"BMI, body weight and F% were measured by Omron Fat Loss Monitor HBF‐351.Before taking a measurement personal data must be entered. Stand with both feet slightly apart. Place both hands on the monitor by holding the grip electrodes. Hold the electrodes with both hands. The monitor automatically starts the measurement."	N/I	N/I	N/I	N/I	N/I
Zhang 2012	"Body weight was measured with a standard method. Body weight and BMI were measured in the same conditions, e.g., time, clothing, measuring instrument, etc."	"Waist circumference was measured at the midpoint between the lower costal margin and the top of the iliac crest while the subject was in a standing position. Hip circumference was measured around the widest portion of the buttocks, with the tape parallel to the floor. F% were measured by Fat Loss Monitor HBF‐351."	N/I	N/I	N/I	N/I	N/I
Zhang Y 2007	N/D	N/I	N/I	N/I	N/I	N/I	N/I
Zhao 2010	N/D	N/D	N/I	N/I	N/I	N/I	N/I
Zhao 2011	N/D	N/I	N/I	N/I	N/I	N/I	N/I
Zhu 2007	"Participants were measured without shoes or heavy outer clothing."	"Abdominal circumference was measured at the midpoint between the midaxillary line costal margin and the top of the iliac crest while the subject was in a standing position. "	N/I	N/I	N/I	N/I	N/I
N/D: not defined; N/I: not investigated BMI: body mass index; F%: body fat percentage; WC: waist circumference; HC: hip circumference; WHR: waist hip ratio

	Blood pressure^a	Lipid levels	Glycaemic control
Chen 2009	N/I	N/I	"Insulin was measured according to instruction of test kits."
Chen 2013	N/I	N/I	N/I
Dang 2012	N/I	N/I	N/I
Ding 2013	N/I	N/I	"FPG were measured by the glucose oxidase ‐peroxidase method (Siemens ADVIA 2400 Chemistry System ). HbA₁C were measured by Automated Glycohemoglobin Analyzer (Bio‐Rad Laboratories, Inc). 2hPG were measured by radioimmunoassay kit (3V, Shangdong). Homa‐IR = (FPG × Fins) / 22.5."
Duan 2013	N/I	N/I	N/I
Feng 2014	N/I	N/I	N/I
Gucel 2012	N/I	N/I	"Serum insulin was measured by ELISA. Biosource Insulin Elisa Kit (Biosource Europe S.A., Rue du Bosquet, Louvain‐La‐Neuve, Belgium.) was used."
Guo 2011	N/I	"Morning fasting venous bloods were drawn at the beginning of first session and after completion of all sessions."	"Morning fasting venous bloods were drawn at the beginning of first session and after completion of all sessions."
He 2012	N/I	N/I	N/I
Hsu 2009	N/I	N/D	"Homeostasis model assessment for insulin resistance (HOMA‐IR) [fasting glucose (mmol=L)fasting insulin (UI=L)=22.5] was used as the insulin resistance measurement. All measurements were made at 8–9 am after an overnight fast using standardized methods."
Hsu 2005a	N/I	N/I	N/I
Hsu 2005b	N/I	N/D	N/D
Lai 2010	N/I	"Insulin, FBG, TC, TG, HDL‐C and LDL‐C were recorded with a standard method between 7.00 and 8.00 am, after the participants had abstained from food since the previous evening."	"Insulin, FBG, TC, TG, HDL‐C and LDL‐C were recorded with a standard method between 7.00 and 8.00 am, after the participants had abstained from food since the previous evening. Homa‐IR = (FBG × Fins) / 22.5. "
Li 2009	N/I	"Participants were measured at designated hospitals."	N/I
Li 2014	N/I	"Insulin, FBG, TC, TG, HDL‐C and LDL‐C were recorded with a standard method between 7.00 and 8.00 am, after the participants had abstained from food since the previous evening."	"Insulin, FBG, TC, TG, HDL‐C and LDL‐C were recorded with a standard method between 7.00 and 8.00 am, after the participants had abstained from food since the previous evening."
Li L 2006	N/I	"The morning fasting venous blood of all subjects were obtained for measuring TC, TG, HDL‐C and LDL‐C."	N/I
Lien 2012	N/I	"The outcomes were evaluated as percentage reduction in four aspects. They were physical parameters (body weight, BMI and waist circumference), biochemical characteristics from whole blood (including fasting blood sugar, triglyceride, total cholesterol levels), obesity‐related hormone peptides and quality of life scores on the WHOQoL‐BREF scale. All measurements were made after 8–9 h of fasting using a standardized method, as detailed in our previous research, at the beginning and the end of the study."	"Obesity‐related hormone peptides including leptin, insulin, ghrelin and adiponectin were measured after 8‐ to 9‐h fasting in the morning at baseline and after 4 weeks of treatment." "BioSource INS‐IRMA Kits (BioSource Europe S.A., Nivelles, Belgium) were employed to determine the level of insulin in serum as reported by Starr et al. . Sampling would be repeated if a difference exceeding 10% CV was found between duplicate results of the sample. Following the approach of Matthews et al., we used the homeostasis model assessment for insulin resistance (HOMA‐IR) for measuring insulin resistance of our subjects at baseline and after treatment."
Liu 2010	N/I	N/I	N/I
Liu 2011	N/I	N/I	N/I
Lu 2014	N/I	N/I	N/I
Luo 2006	N/I	"The morning fasting venous blood of all subjects were obtained at 8–9 AM."	N/I
Mi 2005	N/I	N/I	N/I
Pan 2010	N/I	N/I	N/I
Rerksuppaphol 2011	N/I	N/I	N/I
Schukro 2014	N/I	N/I	N/I
Shan 2008	N/I	N/I	N/I
Shu 2011	N/I	"TC and TG were measured at 8.00 am, after the participants had abstained from food since the previous evening."	N/I
Su 2013	N/I	N/I	"FPG was measured by the glucose oxidase ‐peroxidase method. Insulin was measured with radioimmunoassay. Homa‐IR = (Fins × FPG) / 22.5."
Tao 2009	N/I	N/I	N/D
Tao 2010	N/I	"The morning fasting venous blood of all subjects were obtained for measuring TC, TG, HDL‐C and LDL‐C."	"FPG and insulin were measured in the morning and after receiving oral glucose."
Tong 2011	N/I	N/D	N/D
Wang 2014	N/I	N/I	N/I
Wang X 2006	N/I	"TC, TG and HDL‐C were measured by Hitachi 717 Chemistry Analyzer."	"Glucose was measured by Hitachi 717 Chemistry Analyzer."
Wu 2009	N/I	"TC, TG, HDL‐C and LDL‐C were measured by Chemistry Analyzer."	"FPG was measured by the glucose oxidase ‐peroxidase method. Insulin was measured with radioimmunoassay. Homa‐IR = (Fins × FPG) / 22.5."
Xing 2009	N/I	TG was measured by Glycerol Phosphate Oxidase‐Peroxidase method. TC was measured by cholesterol esterase, cholesterol oxidase and peroxidase method. HDL‐C was measured by Polyethylene glycol method.	N/I
Xiong 2011	N/I	N/I	"Insulin was measured by ELISA. Biosource Insulin Elisa Kit (Jiamay Bio‐tech Co., LTD) was used."
Xu 2008	N/I	N/I	N/I
Xu 2011	N/I	N/I	N/D
Yan 2011	N/I	N/I	N/I
Ye 2010	N/I	N/I	N/I
Yin 2006	N/I	N/D	N/D
Zhang 2005	N/I	"The morning fasting venous blood of all subjects were obtained for measuring TC, TG, HDL‐C LDL‐C and glucose by biochemical laboratory."	"The morning fasting venous blood of all subjects were obtained for measuring TC, TG, HDL‐C LDL‐C and glucose by biochemical laboratory."
Zhang 2011	N/I	N/I	N/I
Zhang 2012	N/I	N/I	N/I
Zhang Y 2007	N/I	N/I	N/I
Zhao 2010	N/I	N/I	N/D
Zhao 2011	N/I	N/I	N/I
Zhu 2007	N/I	N/I	N/I
N/D: not defined; N/I: not investigated FPG: fasting plasma glucose; TC: total cholesterol; TG: triglyceride; FINS: fasting insulin; HbA1c: glycosylated haemoglobin A1c; HDL‐C: high‐density lipoprotein cholesterol; Homa‐IR: homeostasis model assessment of insulin resistance; LDL‐C: low‐density lipoprotein cholesterol

	Intervention(s) and comparator(s)	Participants included in analysis [N]	Deaths [N]	Deaths [%]	All adverse events [N]	All adverse events [%]	Severe/serious adverse events [N]	Severe/serious adverse events [%]
Chen 2009	I1: electro‐acupuncture	20	0	0	‐	‐	‐	‐
	I2: acupuncture	20	0	0	‐	‐	‐	‐
	C: no intervention	20	0	0	‐	‐	‐	‐
Chen 2013	I: catgut embedding therapy	30	0	0	‐	‐	‐	‐
Chen 2013	C: lifestyle control	30	0	0	‐	‐	‐	‐
Dang 2012	I: electro‐acupuncture + lifestyle control	30	0	0	0	0	0	0
	I2: computerized intermediate‐frequency therapy + electro‐acupuncture + lifestyle control	30	0	0	0	0	0	0
	C: lifestyle control	30	0	0	0	0	0	0
Ding 2013	I: acupuncture + lifestyle control	102	0	0	‐	‐	‐	‐
Ding 2013	C: lifestyle control	100	0	0	‐	‐	‐	‐
Duan 2013	I: acupuncture + lifestyle control	45	0	0	0	0	0	0
Duan 2013	C: foot holographic scraping therapy + lifestyle control	45	0	0	1	2	0	0
Feng 2014	I: catgut embedding therapy + lifestyle control	68	0	0	‐	‐	‐	‐
Feng 2014	C: lifestyle control	22	0	0	‐	‐	‐	‐
Gucel 2012	I: acupuncture	20	0	0	‐	‐	‐	‐
Gucel 2012	C: sham acupuncture	20	0	0	‐	‐	‐	‐
Guo 2011	I1: catgut embedding therapy + Chinese herbal medicine + lifestyle control	30	0	0	0	0	0	0
	I2: catgut embedding therapy + lifestyle control	30	0	0	0	0	0	0
	C: Chinese herbal medicine + lifestyle control	30	0	0	0	0	0	0
He 2012	I: acupuncture	30	0	0	‐	‐	‐	‐
He 2012	C: flash‐fire cupping therapy	28	0	0	‐	‐	‐	‐
Hsu 2009	I: auricular acupuncture	23	0	0	8	35	0	0
Hsu 2009	C: sham auricular acupuncture	22	0	0	2	9	0	0
Hsu 2005a	I: electro‐acupuncture	24	0	0	3	13	0	0
Hsu 2005a	C: sit‐up exercise	22	0	0	0	0	0	0
Hsu 2005b	I: electro‐acupuncture	22	0	0	4	18	0	0
	C1: sit‐up exercise	20	0	0	0	0	0	0
	C2: no intervention	21	0	0	0	0	0	0
Lai 2010	I: acupuncture	43	0	0	0	0	0	0
Lai 2010	C: western medicine	43	0	0	21	49	0	0
Li 2009	I: catgut embedding therapy	36	0	0	‐	‐	‐	‐
Li 2009	C: western medicine	38	0	0	‐	‐	‐	‐
Li 2014	I1: acupuncture	49	0	0	0	0	0	0
	I2: acupuncture + western medicine	53	0	0	0	0	0	0
	C: sham acupuncture + western medicine	51	0	0	22	43	0	0
Li L 2006	I1: electro‐acupuncture + lifestyle control	26	0	0	‐	‐	‐	‐
	I2: electro‐auricular acupuncture + auricular acupressure + lifestyle control	29	0	0	‐	‐	‐	‐
	C: lifestyle control	30	0	0	‐	‐	‐	‐
Lien 2012	I1: auricular acupuncture	24	0	0	0	0	0	0
	I2: auricular acupressure	24	0	0	0	0	0	0
	C: sham auricular acupuncture	23	0	0	0	0	0	0
Liu 2010	I1: catgut embedding therapy	21	0	0	‐	‐	‐	‐
	I2: catgut embedding therapy + Chinese herbal medicine	18	0	0	‐	‐	‐	‐
	C: Chinese herbal medicine	20	0	0	‐	‐	‐	‐
Liu 2011	I: electro‐acupuncture	30	0	0	1	3	0	0
Liu 2011	C: low‐frequency electric stimulation therapy	30	0	0	2	6	0	0
Lu 2014	I: catgut embedding therapy + western medicine	20	0	0	‐	‐	‐	‐
Lu 2014	C: western medicine	12	0	0	‐	‐	‐	‐
Luo 2006	I1: electro‐acupuncture	20	0	0	0	0	0	0
	I2: acupuncture	20	0	0	0	0	0	0
	C: no intervention	20	0	0	0	0	0	0
Mi 2005	I: acupuncture	80	0	0	‐	‐	‐	‐
Mi 2005	C: lifestyle control	40	0	0	‐	‐	‐	‐
Pan 2010	I: acupuncture + lifestyle control	48	0	0	‐	‐	‐	‐
Pan 2010	C: sham acupuncture + lifestyle control	26	0	0	‐	‐	‐	‐
Rerksuppaphol 2011	I: electro‐acupuncture	22	0	0	0	0	0	0
Rerksuppaphol 2011	C: transcutaneous electrical acupoint stimulation	23	0	0	0	0	0	0
Schukro 2014	I: electro‐auricular acupuncture	22	0	0	0	0	0	0
Schukro 2014	C: sham auricular acupuncture	23	0	0	8	35	0	0
Shan 2008	I: acupuncture + lifestyle control	72	0	0	‐	‐	‐	‐
Shan 2008	C: lifestyle control	40	0	0	‐	‐	‐	‐
Shu 2011	I1: electro‐acupuncture + lifestyle control	15	0	0	‐	‐	‐	‐
	I2: auricular acupressure + lifestyle control	15	0	0	‐	‐	‐	‐
	C: moxibustion + lifestyle control	15	0	0	‐	‐	‐	‐
Su 2013	I: acupuncture + Chinese herbal medicine + lifestyle control	40	0	0	‐	‐	‐	‐
Su 2013	C: Chinese herbal medicine + lifestyle control	40	0	0	‐	‐	‐	‐
Tao 2009	I: catgut embedding therapy + Chinese herbal medicine	19	0	0	‐	‐	‐	‐
Tao 2009	C: Chinese herbal medicine	19	0	0	‐	‐	‐	‐
Tao 2010	I1: catgut embedding therapy + Chinese herbal medicine	18	0	0	‐	‐	‐	‐
	I2: catgut embedding therapy	19	0	0	‐	‐	‐	‐
	C: Chinese herbal medicine	17	0	0	‐	‐	‐	‐
Tong 2011	I: acupuncture + lifestyle control	76	0	0	‐	‐	‐	‐
Tong 2011	C: sham acupuncture + lifestyle control	42	0	0	‐	‐	‐	‐
Wang 2014	I: acupuncture + lifestyle control	50	0	0	‐	‐	‐	‐
Wang 2014	C: Chinese herbal medicine + lifestyle control	50	0	0	‐	‐	‐	‐
Wang X 2006	I1: electro‐acupuncture	20	0	0	‐	‐	‐	‐
	I2: electro‐acupuncture + Chinese herbal medicine	20	0	0	‐	‐	‐	‐
	C: Chinese herbal medicine	20	0	0	‐	‐	‐	‐
Wu 2009	I: catgut embedding therapy + lifestyle control	30	0	0	3	10	‐	‐
Wu 2009	C: western medicine + lifestyle control	30	0	0	＞25	＞83	‐	‐
Xing 2009	I: acupuncture + lifestyle control	31	0	0	‐	‐	‐	‐
Xing 2009	C: lifestyle control	30	0	0	‐	‐	‐	‐
Xiong 2011	I: acupuncture	18	0	0	‐	‐	‐	‐
	C1: needle‐knife	18			‐	‐	‐	‐
	C2: western medicine	18	0	0	‐	‐	‐	‐
Xu 2008	I: catgut embedding therapy + lifestyle control	30	0	0	‐	‐	‐	‐
Xu 2008	C: Chinese herbal medicine + lifestyle control	30	0	0	‐	‐	‐	‐
Xu 2011	I: acupuncture	100	0	0	‐	‐	‐	‐
Xu 2011	C: western medicine	50			‐	‐	‐	‐
Yan 2011	I: acupuncture + lifestyle control	57	0	0	‐	‐	‐	‐
Yan 2011	C: bian‐stone + lifestyle control	57	0	0	‐	‐	‐	‐
Ye 2010	I: electro‐acupuncture + lifestyle control	48	0	0	‐	‐	‐	‐
Ye 2010	C: lifestyle control	48			‐	‐	‐	‐
Yin 2006	I: acupuncture	50	0	0	0	0	0	0
Yin 2006	C: acupoint plaster application	58	0	0	1	2	0	0
Zhang 2005	I: acupuncture	30	0	0	‐	‐	‐	‐
Zhang 2005	C: magnet plastering therapy	30	0	0	‐	‐	‐	‐
Zhang 2011	I1: electro‐acupuncture + lifestyle control	26	0	0	‐	‐	‐	‐
	I2: electro‐acupuncture + computerized intermediate‐frequency + lifestyle control	26	0	0	‐	‐	‐	‐
	C: lifestyle control	26	0	0	‐	‐	‐	‐
Zhang 2012	I: electro‐acupuncture	15	0	0	1	7	0	0
Zhang 2012	C: sham acupuncture	15	0	0	0	0	0	0
Zhang Y 2007	I: electro‐acupuncture + lifestyle control	32	0	0	‐	‐	‐	‐
Zhang Y 2007	C: lifestyle control	32	0	0	‐	‐	‐	‐
Zhao 2010	I: electro‐acupuncture + lifestyle control	30	0	0	‐	‐	‐	‐
Zhao 2010	C: lifestyle control	30	0	0	‐	‐	‐	‐
Zhao 2011	I: electro‐acupuncture + transcutaneous electrical acupoint stimulation	35	0	0	‐	‐	‐	‐
Zhao 2011	C: sham acupuncture + transcutaneous electrical acupoint stimulation	35	0	0	‐	‐	‐	‐
Zhu 2007	I1: acupuncture+ auricular acupuncture + lifestyle control	42	0	0	‐	‐	‐	‐
	I2: acupuncture+ auricular acupuncture	40	0	0	‐	‐	‐	‐
	C: lifestyle control	38	0	0	‐	‐	‐	‐
"‐" denotes not reported C: comparator; I: intervention

	Intervention(s) and comparator(s)	Participants included in analysis [N]	Discontinued study due to adverse events [N]	Discontinued study due to adverse events [%]	Hospitalisation [N]	Hospitalisation [%]	Outpatient treatment [N]	Outpatient treatment [%]
Chen 2009	I1: electro‐acupuncture	20	‐	‐	‐	‐	‐	‐
	I2: acupuncture	20	‐	‐	‐	‐	‐	‐
	C: no intervention	20	‐	‐	‐	‐	‐	‐
Chen 2013	I: catgut embedding therapy	30	‐	‐	‐	‐	‐	‐
Chen 2013	C: lifestyle control	30	‐	‐	‐	‐	‐	‐
Dang 2012	I: electro‐acupuncture + lifestyle control	30	0	0	0	0	0	0
	I2: computerized intermediate‐frequency therapy + electro‐acupuncture + lifestyle control	30	0	0	0	0	0	0
	C: lifestyle control	30	0	0	0	0	0	0
Ding 2013	I: acupuncture + lifestyle control	102	‐	‐	‐	‐	‐	‐
Ding 2013	C: lifestyle control	100	‐	‐	‐	‐	‐	‐
Duan 2013	I: acupuncture + lifestyle control	45	0	0	0	0	0	0
Duan 2013	C: foot holographic scraping therapy + lifestyle control	45	0	0	0	0	1	2
Feng 2014	I: catgut embedding therapy + lifestyle control	68	‐	‐	‐	‐	‐	‐
Feng 2014	C: lifestyle control	22	‐	‐	‐	‐	‐	‐
Gucel 2012	I: acupuncture	20	‐	‐	‐	‐	‐	‐
Gucel 2012	C: sham acupuncture	20	‐	‐	‐	‐	‐	‐
Guo 2011	I1: catgut embedding therapy + Chinese herbal medicine + lifestyle control	30	0	0	0	0	0	0
	I2: catgut embedding therapy + lifestyle control	30	0	0	0	0	0	0
	C: Chinese herbal medicine + lifestyle control	30	0	0	0	0	0	0
He 2012	I: acupuncture	30	‐	‐	‐	‐	‐	‐
He 2012	C: flash‐fire cupping therapy	28	‐	‐	‐	‐	‐	‐
Hsu 2009	I: auricular acupuncture	23	0	0	0	0	8	35
Hsu 2009	C: sham auricular acupuncture	22	0	0	0	0	2	9
Hsu 2005a	I: electro‐acupuncture	24	0	0	0	0	3	13
Hsu 2005a	C: sit‐up exercise	22	0	0	0	0	0	0
Hsu 2005b	I: electro‐acupuncture	22	0	0	0	0	4	18
	C1: sit‐up exercise	20	0	0	0	0	0	0
	C2: no intervention	21	0	0	0	0	0	0
Lai 2010	I: acupuncture	43	0	0	0	0	0	0
Lai 2010	C: western medicine	43	0	0	0	0	21	49
Li 2009	I: catgut embedding therapy	36	‐	‐	‐	‐	‐
Li 2009	C: western medicine	38	‐	‐	‐	‐	‐
Li 2014	I1: acupuncture	49	0	0	0	0	0	0
	I2: acupuncture + western medicine	53	0	0	0	0	0	0
	C: sham acupuncture + western medicine	51	0	0	0	0	22	43
Li L 2006	I1: electro‐acupuncture + lifestyle control	26	0	0	0	0	0	0
	I2: electro‐auricular acupuncture + auricular acupressure + lifestyle control	29	0	0	0	0	0	0
	C: lifestyle control	30	0	0	0	0	0	0
Lien 2012	I1: auricular acupuncture	24	0	0	0	0	0	0
	I2: auricular acupressure	24	0	0	0	0	0	0
	C: sham auricular acupuncture	23	0	0	0	0	0	0
Liu 2010	I1: catgut embedding therapy	21	‐	‐	‐	‐	‐	‐
	I2: catgut embedding therapy + Chinese herbal medicine	18	‐	‐	‐	‐	‐	‐
	C: Chinese herbal medicine	20	‐	‐	‐	‐	‐	‐
Liu 2011	I: electro‐acupuncture	30	0	0	0	0	1	3
Liu 2011	C: low‐frequency electric stimulation therapy	30	0	0	0	0	2	6
Lu 2014	I: catgut embedding therapy + western medicine	20	‐	‐	‐	‐	‐	‐
Lu 2014	C: western medicine	12	‐	‐	‐	‐	‐	‐
Luo 2006	I1: electro‐acupuncture	20	0	0	0	0	0	0
	I2: acupuncture	20	0	0	0	0	0	0
	C: no intervention	20	0	0	0	0	0	0
Mi 2005	I: acupuncture	80	‐	‐	‐	‐	‐	‐
Mi 2005	C: lifestyle control	40	‐	‐	‐	‐	‐	‐
Pan 2010	I: acupuncture + lifestyle control	48	‐	‐	‐	‐	‐	‐
Pan 2010	C: sham acupuncture + lifestyle control	26	‐	‐	‐	‐	‐	‐
Rerksuppaphol 2011	I: electro‐acupuncture	22	0	0	0	0	0	0
Rerksuppaphol 2011	C: transcutaneous electrical acupoint stimulation	23	0	0	0	0	0	0
Schukro 2014	I: electro‐auricular acupuncture	‐	0	0	0	0	0	0
Schukro 2014	C: sham auricular acupuncture	‐	0	0	0	0	0	0
Shan 2008	I: acupuncture + lifestyle control	72	‐	‐	‐	‐	‐	‐
Shan 2008	C: lifestyle control	40	‐	‐	‐	‐	‐	‐
Shu 2011	I1: electro‐acupuncture + lifestyle control	15	‐	‐	‐	‐	‐	‐
	I2: auricular acupressure + lifestyle control	15	‐	‐	‐	‐	‐	‐
	C: moxibustion + lifestyle control	15	‐	‐	‐	‐	‐	‐
Su 2013	I: acupuncture + Chinese herbal medicine + lifestyle control	40	‐	‐	‐	‐	‐	‐
Su 2013	C: Chinese herbal medicine + lifestyle control	40	‐	‐	‐	‐	‐	‐
Tao 2009	I: catgut embedding therapy + Chinese herbal medicine	19	‐	‐	‐	‐	‐	‐
Tao 2009	C: Chinese herbal medicine	19	‐	‐	‐	‐	‐	‐
Tao 2010	I1: catgut embedding therapy + Chinese herbal medicine	18	‐	‐	‐	‐	‐	‐
	I2: catgut embedding therapy	19	‐	‐	‐	‐	‐	‐
	C: Chinese herbal medicine	17	‐	‐	‐	‐	‐	‐
Tong 2011	I: acupuncture + lifestyle control	76	‐	‐	‐	‐	‐	‐
Tong 2011	C: sham acupuncture + lifestyle control	42	‐	‐	‐	‐	‐	‐
Wang 2014	I: acupuncture + lifestyle control	50	‐	‐	‐	‐	‐	‐
Wang 2014	C: Chinese herbal medicine + lifestyle control	50	‐	‐	‐	‐	‐	‐
Wang X 2006	I1: electro‐acupuncture	20	‐	‐	‐	‐	‐	‐
	I2: electro‐acupuncture + Chinese herbal medicine	20	‐	‐	‐	‐	‐	‐
	C: Chinese herbal medicine	20	‐	‐	‐	‐	‐	‐
Wu 2009	I: catgut embedding therapy + lifestyle control	30	0	0	0	0	3	10
Wu 2009	C: western medicine + lifestyle control	30	0	0	0	0	＞25	＞83
Xing 2009	I: acupuncture + lifestyle control	31	‐	‐	‐	‐	‐	‐
Xing 2009	C: lifestyle control	30	‐	‐	‐	‐	‐	‐
Xiong 2011	I: acupuncture	18	‐	‐	‐	‐	‐	‐
	C1: needle‐knife	18	‐	‐	‐	‐	‐	‐
	C2: western medicine	18	‐	‐	‐	‐	‐	‐
Xu 2008	I: catgut embedding therapy + lifestyle control	30	‐	‐	‐	‐	‐	‐
Xu 2008	C: Chinese herbal medicine + lifestyle control	30	‐	‐	‐	‐	‐	‐
Xu 2011	I: acupuncture	100	‐	‐	‐	‐	‐	‐
Xu 2011	C: western medicine	50	‐	‐	‐	‐	‐	‐
Yan 2011	I: acupuncture + lifestyle control	57	‐	‐	‐	‐	‐	‐
Yan 2011	C: bian‐stone + lifestyle control	57	‐	‐	‐	‐	‐	‐
Ye 2010	I: electro‐acupuncture + lifestyle control	48	‐	‐	‐	‐	‐	‐
Ye 2010	C: lifestyle control	48	‐	‐	‐	‐	‐	‐
Yin 2006	I: acupuncture	50	0	0	0	0	0	0
Yin 2006	C: acupoint plaster application	58	0	0	0	0	1	2
Zhang 2005	I: acupuncture	30	‐	‐	‐	‐	‐	‐
Zhang 2005	C: magnet plastering therapy	30	‐	‐	‐	‐	‐	‐
Zhang 2011	I1: electro‐acupuncture + lifestyle control	26	‐	‐	‐	‐	‐	‐
	I2: electro‐acupuncture + computerized intermediate‐frequency + lifestyle control	26	‐	‐	‐	‐	‐	‐
	C: lifestyle control	26	‐	‐	‐	‐	‐	‐
Zhang 2012	I: electro‐acupuncture	15	0	0	0	0	1	7
Zhang 2012	C: sham acupuncture	15	0	0	0	0	0	0
Zhang Y 2007	I: electro‐acupuncture + lifestyle control	32	‐	‐	‐	‐	‐	‐
Zhang Y 2007	C: lifestyle control	32	‐	‐	‐	‐	‐	‐
Zhao 2010	I: electro‐acupuncture + lifestyle control	30	‐	‐	‐	‐	‐	‐
Zhao 2010	C: lifestyle control	30	‐	‐	‐	‐	‐	‐
Zhao 2011	I: electro‐acupuncture + transcutaneous electrical acupoint stimulation	35
Zhao 2011	C: sham acupuncture + transcutaneous electrical acupoint stimulation	35
Zhu 2007	I1: acupuncture+ auricular acupuncture + lifestyle control	42
	I2: acupuncture+ auricular acupuncture	40
	C: lifestyle control	38
"‐" denotes not reported C: comparator; I: intervention

	Intervention(s) and comparator(s)	Participants included in analysis [N]	Specific adverse events [description]	Specific adverse events [N participants]	Specific adverse events [% participants]
Chen 2009	I1: electro‐acupuncture	20	‐	‐	‐
	I2: acupuncture	20	‐	‐	‐
	C: no intervention	20	‐	‐	‐
Chen 2013	I: catgut embedding therapy	30	‐	‐	‐
Chen 2013	C: lifestyle control	30	‐	‐	‐
Dang 2012	I: electro‐acupuncture + lifestyle control	30	No adverse effect	0	0
	I2: computerized intermediate‐frequency therapy + electro‐acupuncture + lifestyle control	30	No adverse effect	0	0
	C: lifestyle control	30	No adverse effect	0	0
Ding 2013	I: acupuncture + lifestyle control	102	‐	‐	‐
Ding 2013	C: lifestyle control	100	‐	‐	‐
Duan 2013	I: acupuncture + lifestyle control	45	Dizziness	0	0
Duan 2013	C: foot holographic scraping therapy + lifestyle control	45	No adverse effect	1	2
Feng 2014	I: catgut embedding therapy + lifestyle control	68	‐	‐	‐
Feng 2014	C: lifestyle control	22	‐	‐	‐
Gucel 2012	I: acupuncture	20	‐	‐	‐
Gucel 2012	C: sham acupuncture	20	‐	‐	‐
Guo 2011	I1: catgut embedding therapy + Chinese herbal medicine + lifestyle control	30	No adverse effect	0	0
	I2: catgut embedding therapy + lifestyle control	30	No adverse effect	0	0
	C: Chinese herbal medicine + lifestyle control	30	No adverse effect	0	0
He 2012	I: acupuncture	30	‐	‐	‐
He 2012	C: flash‐fire cupping therapy	28	‐	‐	‐
Hsu 2009	I: auricular acupuncture	23	Minor inflammation and mild tenderness	8	35
Hsu 2009	C: sham auricular acupuncture	22	Mild tenderness	2	9
Hsu 2005a	I: electro‐acupuncture	24	Mild ecchymosis and abdominal discomfort	3	13
Hsu 2005a	C: sit‐up exercise	22	No adverse effect	0	0
Hsu 2005b	I: electro‐acupuncture	22	Mild ecchymosis and abdominal discomfort	4	18
	C1: sit‐up exercise	20	No adverse effect	0	0
	C2: no intervention	21	No adverse effect	0	0
Lai 2010	I: acupuncture	43	No adverse effect	0	0
Lai 2010	C: western medicine	43	Nausea, vomiting, diarrhea, dizziness and inappetence	21	49
Li 2009	I: catgut embedding therapy	36	‐	‐	‐
Li 2009	C: western medicine	38	‐	‐	‐
Li 2014	I1: acupuncture	49	No adverse effect	0	0
	I2: acupuncture + western medicine	53	No adverse effect	0	0
	C: sham acupuncture + western medicine	51	Nausea, vomiting, diarrhea, dizziness and inappetence	22	43
Li L 2006	I1: electro‐acupuncture + lifestyle control	26	‐	‐	‐
	I2: electro‐auricular acupuncture + auricular acupressure + lifestyle control	29	‐	‐	‐
	C: lifestyle control	30	‐	‐	‐
Lien 2012	I1: auricular acupuncture	24	No adverse effect	0	0
	I2: auricular acupressure	24	No adverse effect	0	0
	C: sham auricular acupuncture	23	No adverse effect	0	0
Liu 2010	I1: catgut embedding therapy	21	‐	‐	‐
	I2: catgut embedding therapy + Chinese herbal medicine	18	‐	‐	‐
	C: Chinese herbal medicine	20	‐	‐	‐
Liu 2011	I: electro‐acupuncture	30	Fainting during acupuncture	1	3
Liu 2011	C: low‐frequency electric stimulation therapy	30	Fainting during acupuncture	2	6
Lu 2014	I: catgut embedding therapy + western medicine	20	‐	‐	‐
Lu 2014	C: western medicine	12	‐	‐	‐
Luo 2006	I1: electro‐acupuncture	20	No adverse effect	0	0
	I2: acupuncture	20	No adverse effect	0	0
	C: no intervention	20	No adverse effect	0	0
Mi 2005	I: acupuncture	80	‐	‐	‐
Mi 2005	C: lifestyle control	40	‐	‐	‐
Pan 2010	I: acupuncture + lifestyle control	48	‐	‐	‐
Pan 2010	C: sham acupuncture + lifestyle control	26	‐	‐	‐
Rerksuppaphol 2011	I: electro‐acupuncture	22	No adverse effect	0	0
Rerksuppaphol 2011	C: transcutaneous electrical acupoint stimulation	23	No adverse effect	0	0
Schukro 2014	I: electro‐auricular acupuncture	22	No adverse effect	0	0
Schukro 2014	C: sham auricular acupuncture	23	Irritation	8	35
Shan 2008	I: acupuncture + lifestyle control	72	‐	‐	‐
Shan 2008	C: lifestyle control	40	‐	‐	‐
Shu 2011	I1: electro‐acupuncture + lifestyle control	15	‐	‐	‐
	I2: auricular acupressure + lifestyle control	15	‐	‐	‐
	C: moxibustion + lifestyle control	15	‐	‐	‐
Su 2013	I: acupuncture + Chinese herbal medicine + lifestyle control	40	‐	‐	‐
Su 2013	C: Chinese herbal medicine + lifestyle control	40	‐	‐	‐
Tao 2009	I: catgut embedding therapy + Chinese herbal medicine	19	‐	‐	‐
Tao 2009	C: Chinese herbal medicine	19	‐	‐	‐
Tao 2010	I1: catgut embedding therapy + Chinese herbal medicine	18	‐	‐	‐
	I2: catgut embedding therapy	19	‐	‐	‐
	C: Chinese herbal medicine	17	‐	‐	‐
Tong 2011	I: acupuncture + lifestyle control	76	‐	‐	‐
Tong 2011	C: sham acupuncture + lifestyle control	42	‐	‐	‐
Wang 2014	I: acupuncture + lifestyle control	50	‐	‐	‐
Wang 2014	C: Chinese herbal medicine + lifestyle control	50	‐	‐	‐
Wang X 2006	I1: electro‐acupuncture	20	‐	‐	‐
	I2: electro‐acupuncture + Chinese herbal medicine	20	‐	‐	‐
	C: Chinese herbal medicine	20	‐	‐	‐
Wu 2009	I: catgut embedding therapy + lifestyle control	30	Inflammation and swelling	3	10
Wu 2009	C: western medicine + lifestyle control	30	Diarrhea, dizziness, week, drowsiness and reduction of blood pressure	＞25	＞83
Xing 2009	I: acupuncture + lifestyle control	31	‐	‐	‐
Xing 2009	C: lifestyle control	30	‐	‐	‐
Xiong 2011	I: acupuncture	18	‐	‐	‐
	C1: needle‐knife	18	‐	‐	‐
	C2: western medicine	18	‐	‐	‐
Xu 2008	I: catgut embedding therapy + lifestyle control	30	‐	‐	‐
Xu 2008	C: Chinese herbal medicine + lifestyle control	30	‐	‐	‐
Xu 2011	I: acupuncture	100	‐	‐	‐
Xu 2011	C: western medicine	50	‐	‐	‐
Yan 2011	I: acupuncture + lifestyle control	57	‐	‐	‐
Yan 2011	C: bian‐stone + lifestyle control	57	‐	‐	‐
Ye 2010	I: electro‐acupuncture + lifestyle control	48	‐	‐	‐
Ye 2010	C: lifestyle control	48	‐	‐	‐
Yin 2006	I: acupuncture	50	No adverse effect	0	0
Yin 2006	C: acupoint plaster application	58	Skin allergy	1	2
Zhang 2005	I: acupuncture	30	‐	‐	‐
Zhang 2005	C: magnet plastering therapy	30	‐	‐	‐
Zhang 2011	I1: electro‐acupuncture + lifestyle control	26	‐	‐	‐
	I2: electro‐acupuncture + computerized intermediate‐frequency + lifestyle control	26	‐	‐	‐
	C: lifestyle control	26	‐	‐	‐
Zhang 2012	I: electro‐acupuncture	15	Bleeding	1	7
Zhang 2012	C: sham acupuncture	15	No adverse effect	0	0
Zhang Y 2007	I: electro‐acupuncture + lifestyle control	32	‐	‐	‐
Zhang Y 2007	C: lifestyle control	32	‐	‐	‐
Zhao 2010	I: electro‐acupuncture + lifestyle control	30	‐	‐	‐
Zhao 2010	C: lifestyle control	30	‐	‐	‐
Zhao 2011	I: electro‐acupuncture + transcutaneous electrical acupoint stimulation	35	‐	‐	‐
Zhao 2011	C: sham acupuncture + transcutaneous electrical acupoint stimulation	35	‐	‐	‐
Zhu 2007	I1: acupuncture+ auricular acupuncture + lifestyle control	42	‐	‐	‐
	I2: acupuncture+ auricular acupuncture	40	‐	‐	‐
	C: lifestyle control	38	‐	‐	‐
"‐" denotes not reported C: comparator; I: intervention

	Study author contacted [DD/MM/YY]	Study author replied [DD/MM/YY]	Study author asked for additional information [short summary]	Study author provided data [short summary]
Chen 2009	Have no contact information	Have no contact information	Have no contact information	Have no contact information
Chen 2013	Have no contact information	Have no contact information	Have no contact information	Have no contact information
Dang 2012	Have no contact information	Have no contact information	Have no contact information	Have no contact information
Ding 2013	28/09/2014	28/09/2014	no	details of the study design
Duan 2013	Have no contact information	Have no contact information	Have no contact information	Have no contact information
Feng 2014	28/09/2014	02/10/2014	no	details of the study design
Gucel 2012	02/10/2014	07/10/2014	no	details of the study design
Guo 2011	Have no contact information	Have no contact information	Have no contact information	Have no contact information
He 2012	28/09/2014	no reply	no reply	no reply
Hsu 2009	02/10/2014	no reply	no reply	no reply
Hsu 2005a	02/10/2014	no reply	no reply	no reply
Hsu 2005b	02/10/2014	no reply	no reply	no reply
Lai 2010	28/09/2014	no reply	no reply	no reply
Li 2009	Have no contact information	Have no contact information	Have no contact information	Have no contact information
Li 2014	28/09/2014	no reply	no reply	no reply
Li L 2006	28/09/2014	09/10/2014	no	details of the study design
Lien 2012	02/10/2014	no reply	no reply	no reply
Liu 2010	Have no contact information	Have no contact information	Have no contact information	Have no contact information
Liu 2011	Have no contact information	Have no contact information	Have no contact information	Have no contact information
Lu 2014	28/09/2014	06/10/2014	no	details of the study design
Luo 2006	Have no contact information	Have no contact information	Have no contact information	Have no contact information
Mi 2005	28/09/2014	no reply	Have no contact information	Have no contact information
Pan 2010	Have no contact information	Have no contact information	Have no contact information	Have no contact information
Rerksuppaphol 2011	02/10/2014	no reply	no reply	no reply
Schukro 2014	02/10/2014	no reply	no reply	no reply
Shan 2008	Have no contact information	Have no contact information	Have no contact information	Have no contact information
Shu 2011	Have no contact information	Have no contact information	Have no contact information	Have no contact information
Su 2013	Have no contact information	Have no contact information	Have no contact information	Have no contact information
Tao 2009	Have no contact information	Have no contact information	Have no contact information	Have no contact information
Tao 2010	28/09/2014	no reply	no reply	no reply
Tong 2011	28/09/2014	no reply	no reply	no reply
Wang 2014	Have no contact information	Have no contact information	Have no contact information	Have no contact information
Wang X 2006	Have no contact information	Have no contact information	Have no contact information	Have no contact information
Wu 2009	Have no contact information	Have no contact information	Have no contact information	Have no contact information
Xing 2009	Have no contact information	Have no contact information	Have no contact information	Have no contact information
Xiong 2011	Have no contact information	Have no contact information	Have no contact information	Have no contact information
Xu 2008	Have no contact information	Have no contact information	Have no contact information	Have no contact information
Xu 2011	Have no contact information	Have no contact information	Have no contact information	Have no contact information
Yan 2011	Have no contact information	Have no contact information	Have no contact information	Have no contact information

	Acupuncture rationale			Details of needling
	1a	1b	1c	2a	2b	2c	2d	2e	2f	2g
Chen 2009	Traditional Chinese Medicine	Ancient TCM literature	Ten main fixed acupoints and two optional points	‐	The fixed points were Zhongwan (CV12), Guanyuan (CV4), Taichong (LR3), Sanyinjiao (SP6), Neiting (ST44), Daheng (SP15), Tianshu (ST25), Shuidao (ST28), Zhigou (SJ6), Zusanli (ST36) The optional points were Shangjuxu (ST37) and Fujie (SP14) for damp impediment due to Stomach Heat; Fenglong (ST40) and Yinlingquan (SP9) for damp impediment due to Spleen deficiency; Taixi (KI3) and Qihai (CV6) for liver qi stagnation; Pishu (BL20) and Shenshu (BL23) for Yang deficiency in Spleen and Kidney	0.8‐1.2 cun	De qi	Manual and electrical stimulation: manual rotating needle with uniform reinforcing‐reducing method; electrical stimulation: dilatational wave	40 min	Acupuncture: ‐; electrical stimulator: D860
Chen 2013	Catgut embedding therapy	Theory of TCM	Four main fixed acupoints and one to three optional points	‐	Four main fixed acupoints and one to three optional points The fixed points were Zhongwan (CV12), Zhangmen (LR13) and Fenglong (ST40) The fixed points were Tianshu (ST25), Dachangshu (BL25), Shangjuxu (ST37); Ciliao (BL32) for menstrual disorder; Zusanli (ST36) for constipation; Ashixue for fat places	‐	De qi	Manual stimulation: ‐	‐	Catgut: chromic catgut 1‐1.5 cun
Dang 2012	Traditional Chinese Medicine	Theory of TCM and literature sources	Fourteen main fixed acupoints	‐	The fixed points were Zhigou (SJ6), Quchi (LI11), Zhongwan (CV12), Qihai (CV6), Shuifen (CV9), Tianshu (ST25), Shuidao (ST28), Daheng (SP15), Yinlingquan (SP9), Zusanli (ST36), Fenglong (ST40), Neiting (ST44) and Shangjuxu (ST37)	‐	De qi	Manual stimulation: manual rotating needle with uniform reinforcing‐reducing method; electrical stimulation: continuous wave, 2‐15Hz	30 min	Acupuncture: HUAN QIU stainless steel, Φ0.35 × 75mm (3 cun); electrical stimulator: G6805
Ding 2013	Traditional Chinese Medicine	‐	Eight main fixed acupoints and three to four optional points	‐	The fixed points were Yishu (EX‐B4), Chengjiang (CV24), Feishu (), Pishu (BL20), Weishu (BL21), Shenshu (BL23), Zusanli (ST36) and Sanyinjiao (SP6) The optional points were Tianshu (ST25), Neiting (ST44), Hegu (LI14) for excess heat in stomach and intestine; Fenglong (ST40), Yinlingquan (SP9) Zhongwan (CV12) and Qihai (CV6) for predominant dampness due to spleen deficiency; Taichong (LR3), Quanquan (LR8), Jiaxi (GB43) and Qimen (LR14) for liver qi stagnation; Guanyuan (CV4), Zhigou (SJ6), Zhaohai (KI6) and Taixi (KI3) for qi deficiency in kidney	‐	De qi	Manual stimulation: manipulation every 10 min	30 min	Acupuncture: #29 or #30 sterile acupuncture
Duan 2013	Traditional Chinese Medicine	‐	Five main fixed acupoints and four optional points	‐	The fixed points were Zhongwan (CV12), Qihai (CV6), Huaroumen (ST24), Daheng (SP15), Liangqiu (ST34) The optional points were Fenglong (ST40), Neiting (ST44), Hegu (LI14), Quchi (LI11) for excess heat in Stomach and Large intestine; Zusanli (ST36), Sanyinjiao (SP6), Gongsun (SP4), Yinlingquan (SP9) for predominant Dampness due to Spleen deficiency; Danzhong (CV17), Qimen (LR14), Yanglingquan (SP9), Taichong (LR3) for Liver qi stagnation; Guanyuan (CV4), Zusanli (ST36), Sanyinjiao (SP6), Zhaohai (KI6) for yang deficiency in spleen and kidney; Sanyinjiao (SP6), Zusanli (ST36), Neiguan (PC6), Taixi (KI3) for yin deficiency generating interior Heat	0.5‐1 cun	‐	Manual stimulation: manual rotating needle with uniform reinforcing‐reducing method	30 min	Acupuncture: HUANQIU sterile acupuncture (0.25 x 25mm, 0.25 x 40mm)
Feng 2014	Traditional Chinese Medicine	Ancient TCM literature and theory of TCM	Four groups of points	‐	(1)Guilai (ST29), Shuidao (ST28), Daju (ST27) and Wailing (ST26) (2)Daheng (SP15), Qixue (KI13), Siman (KI14) and Zhongzhu (KI15) (3)Dachangshu (BL25), Xiaochangshu (BL27), Pangguangshu (BL28) and Zhishi (BL52) (4)Yaoshu (GV2), Mingmen (GV4), Zhibian (BL52) and Weicang (BL50)	‐	De qi	Manual stimulation: ‐	‐	Catgut:chromic catgut (Shanghai Pudong Jinhuan Medical Products Co., LTD)
Gucel 2012	Traditional Chinese Medicine	Literature sources	Five main fixed acupoints		The fixed points were Hegu (LI14), Shenmen (HT7), Zusanli (ST36), Neiting (ST44) and Sanyinjiao (SP6)	5‐10 mm	De qi	Manual stimulation: ‐	20 min	Acupuncture: disposable stainless steel needles (25 mm long, 0.25 mm in diameter, Kingli, Lianghong Rd
Guo 2011	Catgut embedding therapy	Ancient TCM literature	Four main fixed acupoints and two to three optional points	‐	The fixed points were Pishu (BL20), Zhangmen (LR13), Yinlingquan (SP9) and Zusanli (ST36) The optional points were Liangmen (ST21), Xiawan (CV10) and Daheng (SP15) for fat above the belly button; Guanyuan (CV4), Daju (ST27), Guilai (ST29) for fat below the belly button; Tianshu (ST25) and Daheng (SP15) for abdominal obesity; Daimai (GB26) and Shenshu (BL23) for fat waist; Huantiao (GB30) and Chengfu (BL36) for fleshy hips	Muscular layer (depths unknown)	De qi	Manual stimulation: ‐	‐	Catgut: chromic catgut 2cm
He 2012	Traditional Chinese Medicine	‐	Two groups of points were alternately used	‐	(1)Zhongwan (CV12), Liangmen (ST21), Xiawan (CV10), Tianshu (ST25), Shuifen (CV9), Huaroumen (ST24), Guanyuan (CV4), Qihai (CV6), Fuai (SP16), Fujie (SP14) and Ashixue (2)Geshu (BL17), Pishu (BL20), Weishu (BL21) and Ashixue	The depth of needle insertion varied with thickness of the subcutaneous fatty tissues	‐	Manual stimulation: manual rotating needle with lifting and thrusting; manipulation every 10 min	30 min	‐
Hsu 2005a	Traditional Chinese Medicine	Theory of TCM, clinical experience and consensus method	Nine main fixed acupoints	‐	The fixed points were Qihai (CV6), Shuifen (CV9), Shuidao (ST28), Suidao (ST28), Siman (KI14), Siman (KI14), Zusanli (ST26), Fenglong (ST40), Sanyinjiao (SP6)	Approximately 2.5cm	De qi	Manual stimulation: manual rotating needle (in the lower legs); electrical stimulation: dilatational wave, 42 Hz, 390 ms square pulse, and at a maximal tolerable intensity, 500Ω (12–23 V) (a strong, but not painful sensation to the patient)	40 min	Acupuncture: stainless‐steel acupuncture needles (3.8cm long), electrical stimulator: GWO‐JIH, MODEL‐05, Taiwan
Hsu 2005b	Traditional Chinese Medicine	Theory of TCM and clinical experience	Eight main fixed acupoints	‐	Qihai (CV6), Shuifen (CV9), Shuidao (ST28), Suidao (ST28), Siman (KI14), Zusanli (ST26), Fenglong (ST40), Sanginjao (SP6)	Approximately 2.5 cm	De qi	Manual stimulation: manual rotating needle (in the lower legs); electrical stimulation: dilatational wave, 42 Hz, 390 ms square pulse, and at a maximal tolerable intensity, 500Ω (12–23 V) (a strong, but not painful sensation to the patient)	40 min	Acupuncture: stainless‐steel acupuncture needles (3.8cm long); electrical stimulator: GWO‐JIH, MODEL‐05, Taiwan
Hsu 2009a	Auricular acupuncture	Theory of TCM and clinical experience	Four main fixed acupoints	‐	Hunger point (Jidian), shenmen point (TF4), stomach point (CO4), and endocrine point Needles (CO18)	‐	‐	Manual stimulation: ‐	Three days	Auricular acupuncture: special stainless steel auricular acupuncture needles (36‐gauge 0.5‐inch) were made into a thumbtack form with a 0.2‐cm needle point and a 1.0‐cm annular‐shaped needle handle
Lai 2010	Traditional Chinese Medicine	Theory of TCM	Five main fixed acupoints	‐	Zhongwan (CV12), Xiawan (CV10), Qihai (CV6), Guanyuan (CV4) and Liangmen (ST21)	‐	‐	Manual stimulation: manual without any manipulation	30 min	Acupuncture: 0.25 mm × 40 mm
Li 2009	Catgut embedding therapy	‐	Eight main fixed acupoints	‐	Zusanli (ST36), Fenglong (ST40), Zhongwan (CV12), Liangmen (ST21), Tianshu (ST25), Quchi (LI11), Fujie (SP14), Shangjuxu (ST37)	‐	De qi	Manual stimulation: Zusanli (ST36), Fenglong (ST40), Liangmen (ST21), Tianshu (ST25), Quchi (LI11), Fujie (SP14) and Shangjuxu (ST37) reducing by manual lifting and thrusting needle; Zhongwan (CV12) by manual lifting and thrusting needle with uniform reinforcing‐reducing method	‐	Catgut: chromic catgut 1cm
Li 2014	Traditional Chinese Medicine	Ancient TCM literature	Seven main fixed acupoints	‐	Zhongji (CV3), Guanyuan (CV4), Zigong, Sanyinjiao (SP6), Fuliu (KI17), Zusanli (ST36) and Qixue (KI13)	4‐5 mm	De qi	Manual stimulation: manipulation every 10 min	30 min	‐
Li L 2006	Traditional Chinese Medicine	Ancient TCM literature	Thirteen main fixed acupoints		Sanyinjiao (SP6), Tianshu (ST25), Zusanli (ST36), Quchi (LI11), Fenglong (ST40), Neiting (ST44), Zhongwan (CV12), Pishu (BL20), Shenshu (BL23), Qihai (CV6), Yinlingquan (SP9), Shangjuxu (ST37), Taichong (LR3)	‐	De qi	Manual stimulation: manual manipulating the needle with uniform reinforcing‐reducing method	10 min	Acupuncture: Hwato stainless steel, Φ0.32 × 0.65mm; auricular acupuncture: Hwato stainless steel, Φ0.32 × 25mm; electrical stimulator: G6805‐Ⅱ
Lien 2012	Auricular acupuncture	Theory of TCM and clinical experience	Four main fixed acupoints	‐	Shenmen (TF4), Wei (CO4), hunger point (Jidian) and Neifenmi (CO18)	‐	‐	Manual stimulation: ‐	Two days	Auricular acupuncture: standardized stainless auricular acupuncture needles with a 0.2 cm tip and a 1.0 cm annular‐shaped body
Liu 2010	Catgut embedding therapy	‐	One group of points	‐	(1)Ganshu (BL18), Zhongji (CV3), Geshu (BL17), Zusanli (ST36), Sanyinjiao (SP6), Daimai (GB26), Guanyuan (CV4); (2)Shenshu (BL23), Pishu (BL20), Tianshu (ST25), Shuifen (CV9), Yinlingquan (SP9), Fenglong (ST40), Luancao	‐	‐	Manual stimulation: ‐	Two days	Catgut: #3‐0 catgut 0.7 cm
Liu 2011	Traditional Chinese Medicine	Ancient TCM literature and literature sources	Ten main fixed acupoints and two optional points	‐	The fixed points were Shuifen (CV9), Guanyuan (CV4), Tianshu (ST25), Shuidao (ST28), Zhongwan (CV12), Daheng (SP15), Daimai (GB26), Zusanli (ST36), Fenglong (ST40) and Sanyinjiao (SP6) The optional points were Yinlingquan (SP9) and Xuehai (SP10) for predominant dampness due to spleen deficiency; Neiting (ST44) and Quchi (LI11) for excess heat in stomach and intestine; Yinlingquan (SP9) and Taichong (LR3) for liver qi stagnation; Shenshu (BL23) and Mingmen (GV4) for yang deficiency in spleen and kidney; Sanyinjiao (SP6) and Taixi (KI3) for internal heat due to yin deficiency	‐	‐	Manual stimulation: ‐; electrical stimulation: continuous wave, 3 mA, 7 Hz	30 min	Acupuncture: HUANQIU stainless steel, Φ0.3 × 0.4mm; electrical stimulator: ‐
Lu 2014	Catgut embedding therapy	‐	Two groups of points	‐	(1)Ganshu (BL18), Pishu (BL20) ,Shenshu (BL23), Yanglingquan (GB34), Sanyinjiao (SP6) and Fenglong (ST40); (2)Zhongwan (CV12), Xiawan (CV10), Tianshu (ST25), Guilai (ST29), Guanyuan (CV4), Zigong and Yinlingquan (SP9)	‐	‐	Manual stimulation: ‐	‐	‐
Luo 2006	Traditional Chinese Medicine	Theory of TCM	Twenty four main fixed acupoints		Liangqiu (ST34), Xuehai (SP10), Zusanli (ST36), Fenglong (ST40), Quchi (LI11), Neiguan (PC6), Zhigou (SJ6), Waiguan (SJ5), Yinlingquan (SP9), Sanyinjiao (SP6), Taixi (KI3),Taichong (LR3), Shangjuxu (ST37), Xiajuxu (ST39), Gongsun (SP4), Neiting (ST44), Shuifen (CV9), Zhongwan (CV12), Fujie (SP14), Daimai (GB26), Tianshu (ST25), Wailing (ST26), Daju (ST27), Shuidao (ST28)	‐	De qi	Manual stimulation: ‐; electrical stimulation with dilatational wave	40 min	Acupuncture: Hwato stainless steel, Φ0.35 × 50mm, 0.35x40mm, 0.35x25mm; electrical stimulator: G6805‐B
Mi 2005	Traditional Chinese Medicine	Theory of TCM	Eighteen main fixed acupoints and six to seven optional points	‐	The fixed points were Zusanli (ST36), Sanyinjiao (SP6), Neiting (ST44), Liangqiu (ST34), Shangjuxu (ST37), Xiajuxu (ST39), Tianshu (ST25), Daheng (SP15), Zhongwan (CV12), Pishu (BL20), Weishu (BL21), Zhangmen (LR13), Neiguan (PC6), Qihai (CV6), Fenglong (ST40), Guanyuan (CV4), Zhigou (SJ6), Taixi (KI3) The optional points were Dachangshu (BL25), Xiaochangshu (BL27), Erjian (LI2), Shangwan (CV13), Xiawan (CV10), Zhiyang (GV10) for excess heat in stomach and intestine; Yinlingquan (SP9), Shuifen (CV9), Shuidao (ST28), Taibai (SP3), Fujie (SP14), Taiyang (EX‐HN5), Baihui (GV20) for predominant dampness due to spleen deficiency; Taichong (LR3), Xingjian (LR2), Qimen (LR14), Ligou (LR5), Ququan (LR8) for liver qi stagnation	‐	‐	Manual stimulation: manipulating needle with uniform reinforcing‐reducing method every 10 min	35 min	Acupuncture: Φ 0.30 mm needles
Pan 2010	Traditional Chinese Medicine	Theory of TCM and clinical experience	Thirteen main fixed acupoints	‐	The fixed points were Tianshu (ST25), Daheng (SP15)， Zhongwan (CV12), Xiawan (CV10), Shimen (CV5), Zhongji (CV3), Liangqiu (ST34), Zusanli (ST36), Yinlingquan (SP9) and points at the upper left, lower left, upper right and lower right of umbilicus	‐	‐	Manual stimulation: manipulating needle with uniform reinforcing‐reducing method	30 min	Acupuncture: Korea acupuncture (DONGBANG ACUPUNCTURE)
Rerksuppaphol 2011	Traditional Chinese Medicine	Literature sources	Seven main fixed acupoints	‐	Guanyuan (CV4), Qihai (CV6), Xiawan (CV10), Zhongwan (CV12), Tianshu (ST25), Shuidao (ST28), Daheng (SP15)	‐	‐	Manual stimulation: ‐; electrical stimulation: continuous wave, 0.2 ms pulses, 40Hz	30 min	Acupuncture: disposable needles (0.25 x 25mm); electrical stimulator: HM Stim2 fit (Wuxi Jiajian Medical Instrument Co Ltd, Wuxi, China)
Schukro 2014	Traditional Chinese Medicine	Literature sources	Four main fixed acupoints	‐	Wei (CO4), hunger point (Jidian) and Dachang (CO7) Points were applied on only one ear in each treatment	‐	‐	Manual stimulation: ‐	Four days	electro‐acupuncture device: P‐Stim® electro‐acupuncture device (Biegler GmbH. Allhangstrasse 18a, 3001 Mauerbach, Austria); acupuncture: sterile, single use permanent needles (titanium, 27 gauge, length 3 mm)
Shan 2008	Traditional Chinese Medicine	Theory of TCM	Fifteen main fixed acupoints and two to three optional points	‐	The fixed points were Xiawan (CV10), Daheng (SP15), Qihai (CV6), Tianshu (ST25), Zusanli (ST36), Fenglong (ST40), Taichong (LR3), Jianfeixue (midpoint between CV 8 and anterior superior iliac spine), Pishu (BL20), Weishu (BL21), Dachangshu (BL25), Shenshu (BL23), Huantiao (GB30) Ashixue for fat places The optional points were Shangjuxu (ST37) and Zhigou (SJ6) for constipation; Baihui (GV20),Quchi (LI11) and Ganshu (BL18) for hypertension and fatty liver; Guanyuan (CV4), Zhongji (CV3) and Sanyinjiao (SP6) for irregular menstruation; Sanyinjiao (SP6) and Yishu (EX‐B3) for DM; Neiguan (PC6) and Xinshu (BL15) for coronary heart disease; Ashixue for fat places	‐	‐	Manual stimulation: ‐	25‐30 min	Acupuncture: Φ0.30 × 0.60mm
Shu 2011	Traditional Chinese Medicine	Theory of TCM and literature sources	Nine main fixed acupoints	‐	Tianshu (ST25), Shuifen (CV9), Guanyuan (CV4), Zhongwan (CV12), Zusanli (ST36), Shousanli (LI11), Huaroumen (ST24), Sanyinjiao (SP6), Fenglong (ST40)	‐	De qi	Manual stimulation: manual rotating needle with lifting and thrusting manipulation; electrical stimulation: different wave	28 min	Acupuncture: sterile acupuncture needle (KANG SHENG); electrical stimulator: G6805‐Ⅱ
Su 2013	Traditional Chinese Medicine	Theory of TCM and literature sources	Six main fixed acupoints	‐	Guanyuan (CV4), Sanyinjiao (SP6), Daimai (GB26), Shenshu (BL23), Xuehai (SP10) and Zigong (EX‐CA1)	‐	‐	‐	‐	‐
Tao 2009	Catgut embedding therapy	Theory of TCM and literature sources	Two groups of points	‐	(1)Ganshu (BL18), Zhongji (CV3), Geshu (BL17), Zusanli (ST36), Sanyinjiao (SP6), Daimai (GB26), Guanyuan (CV4); (2)Shenshu (BL23), Pishu (BL20), Tianshu (ST25), Shuifen (CV9), Yinlingquan (SP9), Fenglong (ST40), Luancao Points were applied only one group in each treatment	‐	‐	Manual stimulation: ‐	‐	Catgut embedding: # 0‐3 catgut 0.7cm
Tao 2010	Catgut embedding therapy	Theory of TCM	Two groups of points	‐	(1)Ganshu (BL18), Zhongji (CV3), Geshu (BL17), Zusanli (ST36), Sanyinjiao (SP6), Daimai (GB26), Guanyuan (CV4); (2)Shenshu (BL23), Pishu (BL20), Tianshu (ST25), Shuifen (CV9), Yinlingquan (SP9), Fenglong (ST40), Luancao Points were applied only one group in each treatment	‐	‐	Manual stimulation: ‐	‐	Catgut embedding: catgut 0.7 cm
Tong 2011	Traditional Chinese Medicine	Theory of TCM	Thirteen main fixed acupoints	‐	Tianshu (ST25), Daheng (SP15)， Zhongwan (CV12), Xiawan (CV10), Shimen (CV5), Zhongji (CV3), Liangqiu (ST34), Zusanli (ST36), Yinlingquan (SP9) and points at the upper left, lower left, upper right and lower right of umbilicus	‐	De qi	Manual stimulation: manual rotating needle with lifting and thrusting manipulation, manipulating needle every 15 min	30 min	Acupuncture: Korea acupuncture (DONGBANG ACUPUNCTURE)
Wang 2014	Traditional Chinese Medicine	Clinical experience	Nine main fixed acupoints	‐	Zhongwan (CV12), Tianshu (ST25), Daheng (SP15), Quchi (LI11), Zhigou (SJ6), Neiting (ST44), Fenglong (ST40), Shangjuxu (ST37) and Yinlingquan (SP9)	1.5‐2.5 cm	De qi	Manual stimulation: manual rotating needle with lifting and thrusting manipulation with a frequency between 20‐30 times/min	30 min	Acupuncture: sterile acupuncture needle (0.25 × 40 mm)
Wang X 2006	Traditional Chinese Medicine	‐	Seventeen main fixed acupoints	‐	Tianshu (ST25), Daheng (SP15), Zhongwan (CV12), Guanyuan (CV4), Shuifen (CV9), Siman（KI14）, Qihai (CV6), Daimai (GB26), Wushu (GB27), Weidao (GB28), Fenglong (ST40), Shangjuxu (ST37), Zusanli (ST36), Sanyinjiao (SP6), Yinlingquan (SP9), Quchi (LI11), Zhigou (SJ6)	The depth of needle insertion varied with thickness of the subcutaneous fatty tissues at the site of the acupuncture points	De qi	Manual stimulation: manual rotating needle at lower legs; electrical stimulation with dilatational wave	40 min	Acupuncture: (abdominal) gauge 30# with length 2mm and (lower limb) gauge 32# with length 1.5mm
Wu 2009	Catgut embedding therapy	Ancient TCM literature	Eight main fixed acupoints and three to four optional points	‐	The fixed points were Zhongwan (CV12), Shuifen (CV9), Qihai (CV6), Guanyuan (CV4), Tianshu (ST25), Daheng (SP15), Zusanli (ST36), Yinlingquan (SP9) The optional points were Quchi (LI11), Shangjuxu (ST37), Xiajuxu (ST39), Neiting (ST44) for excess heat in stomach and spleen; Sanyinjiao (SP6), Taichong (LR3), Ququan (LR8) for Qi stagnation and blood stasis; Pishu (BL20), Fenglong (ST40), Shuidao (ST28) for phlegm dampness due to spleen deficiency; Pishu (BL20), Shenshu (BL23), Sanyinjiao (SP6), Taixi (KI3) for yang deficiency in spleen and kidney; Ashixue for fat places	‐	De qi	Manual stimulation: ‐	‐	Catgut embedding: #2 catgut 1‐1.5cm
Xing 2009	Traditional Chinese Medicine	‐	Nine main fixed acupoints	‐	Zhongwan (CV12), Tianshu (ST25), Guanyuan (CV4), Zusanli (ST36), Fenglong (ST40), Sanyinjiao (SP6), Pishu (BL20), Weishu (BL21) Ashixue for fat places	‐	De qi	Manual stimulation: manipulating needle 2 min; electrical stimulation: dilatational wave	30 min	Acupuncture: Hwato stainless steel, gauge 30# with length 25mm, 40mm and 50mm; electrical stimulator: G6805‐2A
Xiong 2011	Traditional Chinese Medicine	Theory of TCM and literature sources	Four groups of points	‐	(1)Tianshu (ST25), Daheng (SP15), Fenglong (ST40), Huaroumen (ST24) (2)Zhongwan (CV12), Shuidao (ST28), Liangqiu (ST34), Wailing (ST26) (3)Ashixue, Shuifen (CV9), Sanyinjiao (SP6), Liangmen (ST21) (4)Daimai (GB26), Daju (ST27), Fengshi (GB31), Shangjuxu (ST37)	The depth of needle insertion varied with thickness of the subcutaneous fatty tissues	De qi	Manual stimulation: manual rotating needle with lifting and thrusting manipulation every 10 min	40 min	Acupuncture: disposable needles (0.30 × 40mm, 0.30 × 75mm)
Xu 2008	Catgut embedding therapy	Ancient TCM literature	Two main fixed acupoints	‐	Zusanli (ST36), Neiting (ST44)	Zusanli (ST36): 1.8cm; Neiting (ST44): 0.8cm	De qi	Zusanli (ST36): manual rotating needle with uniform reinforcing‐reducing method; Neiting (ST44): manual rotating needle with reducing method	‐	Catgut embedding: catgut 0.5, 1.5cm
Xu 2011	Traditional Chinese Medicine	Theory of TCM	Fifteen main fixed acupoints	‐	Jianyu (LI15), Binao (LI14), Quchi (LI11),Pianli (LI16), Hegu (LI4), Biguan (ST31), Futu (ST32), Zusanli (ST36), Shangjuxu (ST37), Fenglong (ST40), Liangmen (ST21), Taiyi (ST23), Tianshu (ST25), Daju (ST27), Guilai (ST29)	‐	‐	Manual stimulation: cannot manipulate needle with lifting and thrusting method in the abdominal	30 min	Acupuncture: stainless steel, 2cun

		(1) Weight loss (kg)	(2) Morbidity	(3) Adverse events	(4) Change in anthropometric measures other than weight loss: BMI	(5) Health‐related quality of life	(6) Scioeconomic effects
Trial limitations (risk of bias)^a	Was random sequence generation used (i.e. no potential for selection bias)?	Yes	‐	Yes	Yes	‐	‐
	Was allocation concealment used (i.e. no potential for selection bias)?	Yes	‐	Yes	Yes	‐	‐
	Was there blinding of participants and personnel (i.e. no potential for performance bias) or outcome not likely to be influenced by lack of blinding?	Yes	‐	Yes	Yes	‐	‐
	Was there blinding of outcome assessment (i.e. no potential for detection bias) or was outcome measurement not likely to be influenced by lack of blinding?	No (↓)	‐	Yes	Yes	‐	‐
	Was an objective outcome used?	Yes	‐	Yes	Yes	‐	‐
	Were more than 80% of participants enrolled in trials included in the analysis (i.e. no potential reporting bias)?^e	Yes	‐	Unclear	Yes	‐	‐
	Were data reported consistently for the outcome of interest (i.e. no potential selective reporting)?	Yes	‐	Unclear	Yes	‐	‐
	No other biases reported (i.e. no potential of other bias)?	Yes	‐	Yes	Yes	‐	‐
	Did the trials end up as scheduled (i.e. not stopped early)?	Yes	‐	Yes	Yes	‐	‐
Inconsistency^b	Point estimates did not vary widely?	N/A	‐	‐	Yes	‐	‐
	To what extent did confidence intervals overlap (substantial: all confidence intervals overlap at least one of the included studies point estimate; some: confidence intervals overlap but not all overlap at least one point estimate; no: at least one outlier: where the confidence interval of some of the studies do not overlap with those of most included studies)?	N/A	‐	‐	Substantial	‐	‐
	Was the direction of effect consistent?	N/A	‐	‐	Yes	‐	‐
	What was the magnitude of statistical heterogeneity (as measured by I²) ‐ low (I²<40%), moderate (I² 40%‐60%), high I²>60%)?	N/A	‐	‐	Low	‐	‐
	Was the test for heterogeneity statistically significant (P < 0.1)?	N/A	‐	‐	Not statistically significant	‐	‐
Indirectness^a	Were the populations in included studies applicable to the decision context?	Highly applicable	‐	Highly applicable	Highly applicable	‐	‐
	Were the interventions in the included studies applicable to the decision context?	Highly applicable	‐	Highly applicable	Highly applicable	‐	‐
	Was the included outcome not a surrogate outcome?	Yes	‐	Yes	Yes	‐	‐
	Was the outcome timeframe sufficient?	Sufficient	‐	Sufficient	Sufficient	‐	‐
	Were the conclusions based on direct comparisons?	Yes	‐	Yes	Yes	‐	‐
Imprecision^c	Was the confidence interval for the pooled estimate not consistent with benefit and harm?	N/A	‐	N/A	Yes	‐	‐
	What is the magnitude of the median sample size (high: 300 participants, intermediate: 100‐300 participants, low: <100 participants)?^e	Low (↓)	‐	Low (↓)	Low (↓)	‐	‐
	What was the magnitude of the number of included studies (large: >10 studies, moderate: 5‐10 studies, small: <5 studies)?^e	Small (↓)	‐	Small (↓)	Small (↓)	‐	‐
	Was the outcome a common event (e.g. occurs more than 1/100)?	Yes	‐	Yes	Yes	‐	‐
Publication bias^d	Was a comprehensive search conducted?	Yes	‐	Yes	Yes	‐	‐
	Was grey literature searched?	Yes	‐	Yes	Yes	‐	‐
	Were no restrictions applied to study selection on the basis of language?	Yes	‐	Yes	Yes	‐	‐
	There was no industry influence on studies included in the review?	Yes	‐	Yes	Yes	‐	‐
	There was no evidence of funnel plot asymmetry?	Unclear	‐	Unclear	Unclear	‐	‐
	There was no discrepancy in findings between published and unpublished trials?	Unclear	‐	Unclear	Unclear	‐	‐
^aQuestions on risk of bias are answered in relation to the majority of the aggregated evidence in the meta‐analysis rather than to individual trials ^bQuestions on inconsistency are primarily based on visual assessment of forest plots and the statistical quantification of heterogeneity based on I² ^cWhen judging the width of the confidence interval it is recommended to use a clinical decision threshold to assess whether the imprecision is clinically meaningful ^dQuestions address comprehensiveness of the search strategy, industry influence, funnel plot asymmetry and discrepancies between published and unpublished trials ^eDepends on the context of the systematic review area (↓): key item for possible downgrading the quality of the evidence (GRADE) as shown in the footnotes of the 'Summary of finding' table(s); GRADE: Grading of Recommendations Assessment, Development and Evaluation; N/A: not applicable; "‐" denotes not reported

PERMALINK

Acupuncture for overweight or obese people

Jie Li

Ying Lu

Mei Yu Shi

George Lenon

Qing Li

Yin Shi

Abstract

Background

Description of the condition

Description of the intervention

Adverse effects of the intervention

How the intervention might work

Why it is important to do this review

Objectives

Methods

Criteria for considering studies for this review

Types of studies

Types of participants

Diagnostic criteria

Types of interventions

Intervention

Comparator

Exclusion criteria

Types of outcome measures

Primary outcomes

Secondary outcomes

Method and timing of outcome measurement

Summary of findings

Search methods for identification of studies

Electronic searches

Searching other resources

Data collection and analysis

Selection of studies

Data extraction and management

Table 1.

Assessment of risk of bias in included studies

Measures of treatment effect

Unit of analysis issues

Dealing with missing data

Assessment of heterogeneity

Assessment of reporting biases

Data synthesis

Subgroup analysis and investigation of heterogeneity

Sensitivity analysis

Acknowledgements

Appendices

Appendix 1. Search strategies

Appendix 2. Description of interventions

Appendix 3. Baseline characteristics (I)

Appendix 4. Baseline characteristics (II)

Appendix 5. Matrix of study endpoints (publications and trial documents)

Appendix 6. Examination of outcome reporting bias according to ORBIT classification

Appendix 7. Definition of endpoint measurement (I)

Appendix 8. Definition of endpoint measurement (II)

Appendix 9. Adverse events (I)

Appendix 10. Adverse events (II)

Appendix 11. Adverse events (III)

Appendix 12. Survey of authors providing information on trials

Appendix 13. STRICTA 2010 items of information for clinical trials of acupuncture (I)

Appendix 14. STRICTA 2010 items of information for clinical trials of acupuncture (II)

Appendix 15. Checklist to aid consistency and reproducibility of GRADE assessments (acupuncture vs sham acupuncture)

Appendix 16. Checklist to aid consistency and reproducibility of GRADE assessments (acupuncture vs Chinese herbal medicines)

Appendix 17. Checklist to aid consistency and reproducibility of GRADE assessments (acupuncture vs foot holographic scraping therapy)

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