Abstract
Objective This review investigated the effects and safety of Chinese herbal medicine (CHM) formulas on weight management. Methods Eighteen databases in English, Chinese, Korean, and Japanese were searched from their inceptions to September 2019. The treatment groups included CHM formulations, and the control included placebo, Western medication (WM), and lifestyle intervention (LI), with or without cointerventions (WM and/or LI). Quality of studies was assessed using Cochrane Collaboration's risk of bias assessment tool. Body weight and body mass index (BMI) were analysed in RevMan v5.4.1 and expressed as mean differences with 95% confidence intervals (CI), while adverse events were expressed as risk ratio with 95% CI. Results Thirty-nine RCTs were eligible for qualitative analysis, 34 of which were included in the meta-analyses. The majority of studies had a high or unclear risk of selection, performance, and detection bias. Twenty-five CHM studies involving cointerventions revealed that CHM had significant adjunct effects on body weight and BMI at the end of treatment compared to control. No serious adverse events were reported in the CHM groups. Conclusion CHM indicates a promising adjunct to facilitate WM or lifestyle change for weight management. However, methodological barriers such as lack of allocation concealment and double-blinding may have led to challenges in data synthesis. More rigorously designed RCTs involving cointerventions are warranted.
Highlights
Obesity is defined as excess fat accumulation that may lead to serious health conditions such as type 2 diabetes mellitus, coronary heart disease, ischaemic stroke, and certain types of cancer [1, 2]
E first-line therapy for weight management recommended by the Australian National Health and Medical Research Council includes caloric restriction and increasing physical activity [4]. ese, were reported to have low compliance and a stricter regime may be required before significant weight loss can be observed [5]
Current antiobesity medications approved by the US Food and Drug Administration (FDA) for inhibiting fat absorption were subjected to a high incidence of gastrointestinal adverse events such as nausea, vomiting, abdominal discomfort, diarrhoea, and steatorrhoea
Summary
Obesity is defined as excess fat accumulation that may lead to serious health conditions such as type 2 diabetes mellitus, coronary heart disease, ischaemic stroke, and certain types of cancer [1, 2]. Previous systematic reviews could not draw robust conclusions to confirm the weight loss effects of CHM formulations, as a result of methodological limitations and the inherent heterogeneity in study designs [11, 12]. All human RCTs with or without blinding were considered if they (1) involved adult participants (18+ years) irrespective of gender or ethnic background and were overweight or obese as diagnosed according to the standard cut-off points for body weight, BMI, and/or waist circumference [16]; (2) applied oral administration of CHM formulations consisting two or more herbs in the treatment group; (3) compared CHM treatment with placebo, no treatment, Western medication (WM), or lifestyle intervention (LI, including diet and exercise); or (4) included body weight (kilograms) and/or BMI (kilograms/metre2) as outcome measures. Statistical significance was set at a value of p < 0.05
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