Comparative effectiveness of Hypericum perforatum, acupuncture, and lifestyle modification in the management of obesity: A randomized clinical trial

Abstract

Introduction: Obesity is a burden on health which is managed in a multidisciplinary manner with lifestyle modification (LSM) and medication. Acupuncture may be promising although uncertain. Hypericum perforatum (HP) has been used in animal but not in human studies. We aimed to investigate the integrative effect of HP, acupuncture, and LSM in obesity management. Methods: In a blinded randomized trial in Iran, completed in 2018, 88 obese or overweight participants were assigned to 4 groups: A: HP + sham acupuncture + LSM; B: placebo + acupuncture + LSM; C: placebo+ sham acupuncture + LSM; D: HP+ acupuncture + LSM; 6 weeks treatment, 18 weeks follow up. The primary outcome was the change in BMI at week 2, 6 and 24 compared to baseline. The statistical analyses were performed using SAS University (PROC GLIMMIX) and SPSS 18 (Chicago, IL, USA) with a 2-sided P value of less than 0.05 considered statistically significant. Results: Of the eighty-eight enrolled participants, 82 were included in the analyses. No significant differences between the groups regarding anthropometric changes were noted. The appetite score (lower in A and B groups than C; P = 0.037; P = 0.049) and the mean (SD) serum nesfatin-1(in A vs. C, difference of 5.5 ng/dl; 95% CI, 3.7–7.3; P < 0.001; and in the B vs. C, difference of 7.6 ng/dl; 95% CI, 5.1–10.2; P < 0.001) changed significantly. Conclusions: Both HP and acupuncture added to the decreasing effect of LSM on appetite in obese and overweight subjects which might be related to increasing the nesfatin-1 level. Trial registration: Iranian Registry of Clinical Trials; code no. IRCT201706107265N9; date: 2017-06-24.