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Table of Contents
CASE REPORT
Year : 2019  |  Volume : 2  |  Issue : 2  |  Page : 99-104

Treatment of Obesity with Western Medicine and Traditional Medicine: Based on PubMed and Science Direct Databases


TCM Outpatient Department of Internal Medicine, Shanghai 7th Peoples Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China

Date of Web Publication19-Jun-2019

Correspondence Address:
Miss. Gabriella Korio
No.1200 Cailun Road, Zhangjiang High-tech Park, Pudong New District, Shanghai
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CMAC.CMAC_21_19

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  Abstract 


The objective of this review was to collect the current published research on obesity and gain insight into the association of treatment based on a global aspect. The first section of the review will cover the treatment of obesity based on a Western medicine lens. The second section of the review will cover the treatment through a traditional approach based from different regions of the world (not including China). The third section of the review will cover treatment through a traditional Chinese medicine approach. The most commonly used electronic databases were used to search for articles related to obesity. The articles gathered consist of a broad spectrum from various parts of the world. Terms used in the search bar consisted of “obesity”, “BMI”, “acupuncture”, “traditional Chinese medicine”, etc. The majority of findings were collected from treatment based on both a western medicine and traditional Chinese medicine approach. The published literature collected is predominantly sourced from the online journal databases PubMed and Science Direct. Obesity is an ever-growing issue throughout society today. Different methods have shown effective results in treating this disease. It is crucial to continue exploring different treatment methods in hopes to solve this major public health issue.

Keywords: Acupuncture, BMI, herbal medicine, phlegm, dampness, Simple obesity, traditional Chinese medicine, weightloss, Western Medicine


How to cite this article:
Korio G. Treatment of Obesity with Western Medicine and Traditional Medicine: Based on PubMed and Science Direct Databases. Chin Med Cult 2019;2:99-104

How to cite this URL:
Korio G. Treatment of Obesity with Western Medicine and Traditional Medicine: Based on PubMed and Science Direct Databases. Chin Med Cult [serial online] 2019 [cited 2019 Nov 12];2:99-104. Available from: http://www.cmaconweb.org/text.asp?2019/2/2/99/260707






  Introduction Top


Obesity [Table 1] can be defined as the occurrence of an individual's weight being higher than what is considered as a healthy weight for a given height. An adult's body mass index (BMI) is used as a tool to categorize which category an individual may fall into. A BMI can then be calculated by taking an individuals' weight in kilograms divided by the individuals height in meters.[1] With this BMI, one may distinguish the category they fall under. [Table 2] shows three different categories: Obesity can then be categorized into three different tiers.
Table 1: Adult body mass index chart

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Table 2: Adult obesity BMI index chart

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On the contrary, overweight children can be defined as a BMI at or above the 85th percentile and below the 95th percentile for children and teens of the same age and sex. Obesity can be defined as a BMI at the 95th percentile for children and teens of the same age and sex. Just as an adult's BMI [Table 2] is used to classify one's weight category, the same method is used to find whether a child may be considered obese. This is commonly known as “BMI-for-age [Table 3].” To calculate the BMI, the weight in kilograms is divided by the height in meters. This rising epidemic can be found in all parts of the world. Multiple studies have shown various treatment methods on how to go about in curing this fatal disease.
Table 3: BMI-for-age chart

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However, the BMI standard for the Asian [Table 4] ethnicity group differentiates when compared to the normal standard as mentioned above. The cutoffs for Asian countries are slightly lower for what is to be considered as overweight or obese.[2],[3]
Table 4: BMI for Asians

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With an increase in a sedentary lifestyle, many people lack the recommended amount of exercise for a healthy lifestyle. In addition, a diet enriched in energy-fueled foods and low in fat is often lacked. The World Health Organization claims that this fatal disease has almost tripled in the past 30 years. What was once a problem in only high-income countries has now spread across the globe to both low- and middle-income countries. Global statistics for 2016 shows more than 1.9 billion adults aged 18 years and older were overweight; 650 million adults from this group are considered to be obese. In the same year, findings show over 340 million children and young adults between the ages of 5–19 were either overweight or obese.[4]

With a high BMI, obesity becomes very susceptible throughout the world. Some of the major diseases associated with obesity are cardiovascular disease, musculoskeletal disorders, and cancer. Overweight children are more at risk to be obese later in their life, as well as premature death and disability are more likely to occur.

Objectives

The objective of this review was to collect the current published research on the topic of obesity and gain insight into the association of treatment based on a global aspect. The first section of the review will cover the treatment of obesity based on a western medicine lens. The second section of the review will cover the treatment of obesity through a traditional approach based on different regions of the world (not including Chinese medicine). The third section will cover the treatment of obesity through the traditional Chinese medicine approach.


  Methods Top


The most commonly used electronic databases were used to search for articles related to obesity. The articles gathered consist of a broad spectrum from various parts of the world. The terms used in the search bar consisted of “obesity,” “obese,” “BMI,” “obese treatment,” “acupuncture,” and “traditional Chinese medicine.” A majority of findings were collected from treatment based on both Western medicine and traditional Chinese medicine approach. A total of 328 studies were selected through the primary database collections. Of these collected, 30 publications met our inclusion criteria for this literature review. The published literature collected is sourced from the online journal databases – PubMed and Science Direct.


  Results (Western) Top


The treatment of obesity

Findings show treatment for obesity heavily involves lifestyle changes to an individual's diet and sleeping patterns. Surgical procedures may be necessary if the lifestyle changes are not sufficient.

The treatment of obesity: weight control by time-restricted diet and its effect on circadian patterns

Shifted circadian patterns have shown to play a negative effect of the metabolic production of a species digestive system. A study using mouse models performed an experiment on whether a time-restricted diet affected weight. Mice naturally consume their caloric intake during the evening hours as they are nocturnal (opposite of humans). Results of those who consumed food out of the natural time frame during the day were more prone to obesity. When a time restriction was placed on the obese mice allowing them to only eat during a specific time during the normal feeding hours, there was a significant reduction in weight levels.[5] Individuals who have working hours outside of the normal 9–5 pm schedule may have a greater likelihood of suffering from obesity. Studies have shown that meal patterns have a heavy influence on the metabolic digestive system of an individual.[6] Time-restricted diet within a circadian rhythm may positively influence those who suffer from obesity. A study performed on a group of women showed results of a higher insulin rate after meal consumption. Those who skipped breakfast may be more prone to a higher insulin rate after meal consumption, increased hunger throughout the day, and a decrease in satisfaction.[7] These effects are known to be a causing factor in obesity. It is also important not to abstain from eating foods or drinks as this may cause a desynchrony in the metabolic digestive system.[8] If one struggles from obesity, it is of their best interest for food intake to occur in the early parts of the day such as breakfast as this is the best time for consumption to have glucose control.

The treatment of obesity: structured diet plan organized by a mobile app

Between 2012 and 2013, a mobile app designed in La Jolla, California, USA, was utilized as a means to measure the effects of food intake based on individuals' rhythm of ingestion. Theoverweight individuals who qualified for the case study wererequired to fall into the BMI group >25 kg/m−1 and maintain a dailyfood intake taking place within a 14-h time frame. All participantsqualified as obese with BMI's >30. The participants were asked to report on their mobile device app each time ingestion occurred including water. Each obese member of the study was allowed to eat within a 10-h interval for one given day. Results show that when shortening the duration of one's diet, a decrease in weight is greatly influenced. The average reduction in weight loss was 3.27 kg; these results remained intact 36 weeks after the initial treatment. However, there are still many factors that can disturb a study such as this one including exercise, genetics, diet quality, and sleeping timetable. There is also the concept to be considered: recording daily consumptions will in fact make an individual more aware of their choices, which will result in a natural instinct to make healthier choices when determining consumption.[9]

The treatment of obesity: Egg breakfast enhances weight loss

A study performed in the USA showed that consumption of eggs during the breakfast had great effects on weight loss. The individuals (n = 152) were required to have a BMI ≥25 and ≤50 kg and be between the ages of 25–60 years. The individuals were split among two groups: egg diet and bagel diet (BD). Both groups continued the same amount of energy density and total energy. The egg breakfast contained two eggs (340 kcal) and was consumed 5 days/week. Both groups were required to stay within a low-fat 1000 kcal daily intake. After 8 weeks, in comparison to the BD group, the ED group showed a 61% greater reduction in BMI (−0.95 ± 0.82 vs. −0.59 ± 0.85, P < 0.05), a 65% greater weight loss (−2.63 ± 2.33 vs. −1.59 ± 2.38 kg, P < 0.05), a 34% greater reduction in waist circumference (P < 0.06), and a 16% greater reduction in percent body fat (P = not significant).[10] The study's results show a breakfast including eggs have a higher probability of lowering ones BMI compared to a breakfast diet based solely on carbs.

In China, a similar study was performed on a group of 156 obese Chinese adolescents. The participants were separated into two types of breakfast groups: breakfast with either an egg or steamed bread. Four hours later, the food intake was recorded for each individual. Using radioimmunoassay at 0, 30, and 180 min, the anorexigenic hormones peptide YY (PYY), glucagon-like peptide-1 (GLP-1), and orexigenic hormone gherkin were determined. Results show that those who consumed an egg breakfast showed an increase in satiety causing a decrease in both lunchtime food intake and body weight. The reason for this is due to an increase in serum PYY and GLP-1 (P < 0.001). Researcher claim from the study with a high-protein breakfast obese Chinese adolescents are prone to weight loss.[11]


  Results (Globally) Top


The treatment of obesity: Evidence from gum arabic (acacia senegal)

Gum arabic is formed from the secretion of the Acacia Senegal tree. Most commonly found in Sudan; this sap can be found throughout various parts of Africa.[12] In 2012, a two-arm randomized, placebo-controlled, double-blind trial was conducted in the Department of Physiology at the Khartoum University in Sudan. The purpose was to find the effects gum arabic has on individuals once ingested based on BMI and body fat percentage. The trial consisted of 120 healthy adult females; 60 volunteers received GA (30 g/day) and the 60 volunteers for the placebo group received pectin (1 g/day) for a total of 60 days. After 6 weeks, the results showed a notable decrease in BMI by 0.32, and body fat percentage went down by 2.18%. Researches claim if the study shows positive results on healthy controls, the same could be seen in those suffering from obesity.[13]

The treatment of obesity: evidence from a Korean study

Between April 2015 and December 2016, a study was conducted involving a 23-year-old obese woman with a BMI of 33.9 kg/m2 (body weight, 88.2 kg; height, 161.4 cm). In addition, she suffered from polycystic ovarian syndrome (PCOS); test was performed for proper diagnosis [Table 5]. Before the treatment, she suffered from amenorrhea since August 2014 and had been trying to lose body weight with a low-calorie diet and exercise routine. Nevertheless, all attempts for weight loss were unsuccessful. The Korean herbal medicine (KHM) prescribed to the patient was mixed and decocted with purified water. She was instructed to take three dosages before meals. The table below [Table 5] shows the prescribed KHM concoction: the herbs mentioned in [Table 5] work together harmoniously in creating an effort to reduce weight. This combination is well known among the field of KHM. There were no additional treatment methods included; however, the patient was educated on what a healthy diet consists of and which exercise patterns would be of most benefit. Following the 18 months of treatment, the patients' weight reduced from 88.2 to 66.7 kg. After treatment, the woman menstruation cycle balanced out to occur at a regular rate (1/month).[14]
Table 5: Korean Herbal Medicine Formula

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In 2011, a similar KHM concoction was distributed to 100 female rats; the name of the medicine is known as Chang-Chul-Eui-Ee-In-Tang (CCET). Just as the concoction given to the female patient mentioned previously, both share the same main ingredient of Coicis Semen. This plant is known to help ease feelings of hunger and reduce body weight. The study involving the rates showed a decrease in weight loss.[15]

The treatment of obesity: evidence from a Malaysian-based clinical study with germinated brown rice

Germinated brown rice is commonly known as a whole food carrying various healing aspects known to various parts of the world. Of these healing properties, the nutrient inositol found in germinated brown rice (GBR) helps to increase the speed of fat metabolism, prevent the development of fatty liver, and help regulate blood sugar levels.[16]

The Malaysian Faculty of Medicine and Health Science conducted a study involving 46 male laboratory rats. The specimen involved were used in relation to treating obesity with germinated brown rice. Of the 46 individuals, 11 were subject to treatments involving a normal diet and the remaining 35 were subject to a high-fat diet (HFD). After 8 weeks, the second group of rats reached the ideal size in weight for the treatment of GBR to be administered.

Treatment involved separating the obese rats into 4 separate groups. The first group of 8 were considered the HFD-positive control group. The second group of 8 were given 25% GBR, another 8 were given 50% GBR, and the last group of 8 were given 100% GBR. The remaining three HFD rates were not a part of the remaining experiment as their bodies underwent autopsy to see the gain in weight of the adipose tissue. As a result of weight gain, there was also a prevalence of liver damage found among the obese specimen. GBR was able to reverse the damage of the liver and restore it back to its functional state.

The effects of ingesting GBR show a positive effect in the decrease of food consumption and weight gain. The grain carries features known to lower cholesterol and triglyceride levels which may in result lowering an individual's body weight. GBR is composed of a high amount of dietary fiber, vitamins, and minerals.


  Results (Traditional Chinese Medicine Approach) Top


The treatment of obesity: Evidence from a study using electroacupuncture and Chinese medicine on obese patients with polycystic ovarian syndrome

PCOS is a disease caused by a functionality disorder of the endocrine. This disease often results in many different conditions such as hirsutism, reproductive impairment, hyperandrogenism, chronic anovulation, and obesity, which happens to be the most common factor associated with PCOS. Obesity occurs in over 50% of woman diagnosed with PCOS, and the area most commonly affected is found within the abdominal area. The reasoning behind a metabolic dysfunction is due to a resistance in the action of insulin.[17]

A study was conducted involving 67 female patients with PCOS. The treatment involved the usage of electroacupuncture with Chinese medicinal herbs.[18] A formal diagnosis involved criteria in both Western medicine and the syndrome differentiation in TCM.

Two groups were formed: 33 patients received acupuncture and herbal medicine; the other 34 patients received electroacupuncture and herbal medicine.

All patients were treated according to the system differentiation and were diagnosed as kidney deficiency with phlegm blockage and blood stasis or damp-heat accumulation.

The patients receiving treatment with electroacupuncture and acupuncture were separated into two main groups. Group 1 received bilateral acupoints: Sanyinjiao (SP-6), Xuehai (SP-10), Zusanli (ST-36), Tianshu (ST-25), Daheng (SP-15), Daimai (GB-26), Dahe (KI-12), Zigong (EX-CA-1), Taixi (KI-3), Zhongwan (CV-4), Qihai (CV-6), and Guanyuan (CV-4). Group 2 received bilateral acupoints: Sanyinjiao (SP-6), Taixi (KI-3), Yinlingquan (SP-9), Ganshu (BL-18), Geshu (BL-17), Shenshu (BL-23), Pishu (BL-20), and Ciliao (BL-32).

To treat phlegm blockage and blood stasis, bilateral acupoints: Hegu (LI-4), Gongsun (SP-4), Fenglong (ST-40), and Diji (SP-8) were added. To treat damp-heat accumulation, bilateral acupoints: Zhigou (TE-6), Quchi (LI-11), Taichung (LR-3), and Yanglingquan (GB-34) were added.

For electroacupuncture, needles, 0.28–0.32 mm in diameter and 40–75 mm in length, were inserted into acupoints with uniform reinforcing-reducing method. Points: Tianshi (ST 25), Sanyinjiao (SP 6), Zhongwan (CV 12), and Qihai (CV 6), or Pishu (BL 20), Shenshu (BL 23), Ciliao (BL 32), and Sanyinjiao (SP 6) were connected to a G6805II electric stimulator with continuous wave, 2 Hz frequency, and an electrical current tolerable to patients.

Needles would remain in the body for a total of 40 min with manipulations occurring every 10 min. Patients received treatment three times per week. After a course of 3 treatment cycles, observations of the effects were performed.

The Chinese medicine used for the study is known as a Tiankui capsule; consisting of Di Huang 地黄 (Radix Rehmanniae), Zhi Mu 知母 (Rhizoma Anemarrhenae), Yin Yang Huo 淫羊霍 (Herba Epimedium), Hu Zhang 虎杖 (Polygonum Cuspidatum), Ma Bian Cao 马鞭草 (Verbenae), Dang Gui 当归 (radix Angelicae Sinensis), Tao Ren 桃仁 (Semen Persicae), Huang Jing 黄精 (Rhizoma Polygonati), Shi Chang Pu 石菖蒲 (Rhizoma Acori Graminei), Gui Ban 龟板 (carapax et Plastrum Testudinis), and Bu Gu Zhi 补骨脂 (Fructus Psoraleae). The Tiankui capsule was taken orally, 6 capsules at a time, in both the morning and evening over the course of 3 months.

The treatment of obesity: evidence from mulberry leaf extracts (Sang Ye 桑叶)

The mulberry leaf extract (MLE) has been used in the ancient practice of Chinese Medicine for thousands of years. The common name in Mandarin is 桑叶 “Sang Ye” and the Latin name is Mori Folium. In the TCM aspect, the mulberry leaf is cool in temperature. It has a surface-releasing effect which allows for movement and dispersing throughout the body. The herbal properties mainly connect with the lung and liver meridian channels and carry a bitter and/or sweet taste. The functions associated with the herb are as follows: disperses and scatters wind heat; calms the liver while clearing the eyes; clears the lungs and moistens dryness; and cools the blood and stops bleeding.[19] One study in particular shows how this traditional medicinal herb is used to treat obesity-induced Non Alcoholic Fatty Liver Disease. The results from the experiment showed that MLE greatly reduced body weight. The reasoning behind these results comes from the herbs' functional properties. MLE is capable to reduce the generation of fat lipids through the process of lipogenesis and help aid in the breakdown of fat during the process of lipolysis. In addition, MLE can help regulate the hepatic lipogenesis and lipolysis enzymes, reduce the liver lipid, and help control the oxidative stress of the liver.[20]

After a chemical analysis was complete, results showed that many polyphenols are within the makeup of MLE. The most common polyphenol found in MLE was chlorogenic acid derivative; a great agent for treating obesity. This particular polyphenol functionality consists of increasing energy which in turn promotes an increase in physical activity. Obese-induced laboratory mice show a positive correlation in maintaining glucose metabolism and insulin when injected daily with chlorogenic acid over the course of a 7-week treatment series.[21]

The treatment of obesity: evidence from Ephedra Herba (Ma Huang 麻黄)

Ephedra Herba is a commonly used herb found among the traditional Chinese medicine practice. One known feature of the herbal drug is to improve metabolic disorders. The common name in Mandarin is 麻黄 “Ma Huang” and the Latin name is Ephedra Herba. In the TCM aspect, ephedra is warm in temperature. It has an acrid surface-releasing effect which allows for movement and dispersing throughout the body. The herbal properties mainly connect with the lung and urinary bladder meridian channels and carry a spicy, slightly bitter taste. A bitter taste is commonly linked to a purging effect on the body.[22]

A study using an oral glucose tolerance test was performed on HFD laboratory rats while receiving a high caloric food intake with Ephedra Sinica. Results revealed the Ephedra Sinica unregulated the expression of adiponectin and peroxisome proliferator-activated receptor alpha (and downregulated the expression of tumor necrosis factor-alpha.[23] Thus, by finding these results, it is clear to see that the herb has properties which may reduce obesity.

The treatment of obesity: evidence from green tea (Lu Cha 绿茶)

Historical recordings show emperor Sin-Non declared over 3000 years ago that one cup of tea a day could help rid the body of many diseases.[24] This belief has continued on from generation to generation. Green tea is one of the most common herbal substances consumed by Chinese people; it is deeply rooted in their culture and medicinal practices.[25] The antioxidant epigallocatechin is a chemical compound found in green tea which acts as an agent for weight loss. ECGC injections were given to rats by IP injection; results showed within 2–7 days, body weight could be reduced by about 20%–30%. However, when the injection treatment stopped, the animals gained the weight back.[26],[27]

The caffeine found in green tea may be one of the main agents in the reduction of weight in humans. A study was done in which 70 overweight Caucasians received 4 capsules per day containing 375 catechins, 270 mg epigallocatechin gallate (EGCG) and 150 mg caffeine. Results shows a 4.6% reduction in body weight and a waist circumference by 4.5% after 3 months.[28]

A study was performed on Asian individuals who were instructed to consume 340 ml of tea containing 576 mg catechins daily for 24 weeks. The results from the groups showed a reduction in body fat ratio and waist measurements compared to the control group who had a daily consumption of 340 ml tea with 75 mg catechins.[29] In addition, a group of adult Asian obese individual who consumed green tea pertaining 100 mg EGCG and 87 mg of caffeine per day for 12 weeks lost weight much greater compared to the placebo group that ate similar meals throughout the day with no combustion of tea.[30]


  Discussion Top


The various methods mentioned in this review are evidence which support the treatment of obesity both in a traditional and western sense. Additional analysis is crucial for furthering the expansion on treatments for this disease. Obesity is often times related to poor diet and lack in exercise which may result in the formation of many chronic diseases. The usage of traditional Chinese medicine in the treatment of this disease can bring improvement with great measure due to the low risk effects. Data on the usage of traditional Chinese medicine in relations to the treatment of this disease are scarce. Further research is needed to better asses an understanding of this type of illness.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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