Non-pharmacological and nonsurgical interventions for abdominal obesity in adults: A systematic review and network meta-analysis.

BACKGROUND

Multiple non-pharmacological and nonsurgical interventions have demonstrated efficacy in improving abdominal obesity. However, the optimal intervention remains uncertain. This study aimed to assess the relative effectiveness and safety of these interventions in reducing waist circumference, waist-to-hip ratio, waist-to-height ratio (WHtR), body mass index (BMI), and body weight among adults with abdominal obesity.

METHODS

Eight databases, including PubMed, Web of Science, Excerpta Medica Database, Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, Chinese Biomedical Database, and China Science and Technology Journal Database, were systematically searched from inception to February 20, 2025 for published randomized controlled trials (RCTs). Methodological rigor was assessed through the Cochrane Risk of Bias tool. After establishing direct evidence through pairwise comparisons in STATA 17.0, we implemented a Bayesian hierarchical model in R 4.4.2 to generate treatment rankings for abdominal obesity interventions.

RESULTS

Thirty RCTs (involving 3334 participants) were included in the meta-analysis. Among the interventions, acupoint catgut embedding (ACE) combined with electroacupuncture (EA), ACE combined with manual acupuncture, ACE alone, high-intensity interval training, and warming needle were the 5 most effective interventions for reducing waist circumference in patients with abdominal obesity. For improving waist-to-hip ratio, the top interventions included low-intensity steady-state training, ACE, EA, high-intensity continuous training, and high-intensity continuous training combined with a calorie-restricted diet, while ACE was the most effective intervention for reducing waist-to-height ratio. In terms of BMI and body weight reduction, ACE combined with EA, warming needle, and ACE ranked as the top 3 effective interventions.

CONCLUSION

ACE combined with EA achieved the greatest waist circumference reductions among non-pharmacological and nonsurgical interventions for adults with abdominal obesity, with observed benefits extending to secondary outcomes including BMI and body weight. This integrated therapy exhibits considerable potential for clinical management of abdominal obesity. Future large-scale, multicenter RCTs involving diverse populations are warranted to further validate and refine its application.