Complementary and alternative medicine (CAM) in obesity treatment encompasses diverse healthcare practices used alongside or instead of conventional weight management approaches. Many people seeking weight loss turn to CAM therapies such as herbal supplements, acupuncture, and mindfulness-based interventions, often attracted by the appeal of 'natural' solutions. However, the evidence base for most CAM modalities remains limited, and safety concerns exist, particularly regarding unregulated dietary supplements. In the UK, NICE does not currently recommend any CAM therapy for routine obesity treatment. This article examines the types of CAM used for weight management, evaluates the research evidence, discusses safety considerations, and explores how selected approaches might complement—but never replace—evidence-based interventions within UK clinical practice.

What Is CAM in Obesity Treatment?

Complementary and alternative medicine (CAM) refers to a diverse range of healthcare practices, therapies, and products that fall outside conventional medical treatment. In the context of obesity management, CAM encompasses approaches used either alongside (complementary) or instead of (alternative) evidence-based interventions such as dietary modification, physical activity, behavioural therapy, and pharmacological treatment.

The use of CAM among individuals seeking weight loss is common, though robust UK-specific prevalence data are limited. International surveys suggest that a substantial proportion of people attempting weight management have tried at least one form of CAM. This popularity stems from various factors, including dissatisfaction with conventional treatment outcomes, concerns about pharmaceutical side effects, cultural beliefs, and the appeal of 'natural' approaches. Common CAM modalities in obesity treatment include herbal supplements, acupuncture, mindfulness-based interventions, and various dietary supplements marketed for weight loss. It is important to note that homoeopathy, whilst sometimes used, has no robust evidence for weight management.

It is crucial to distinguish between complementary use—where CAM therapies support conventional treatment—and alternative use, where individuals replace evidence-based interventions entirely with unproven methods. The latter approach carries significant risks, as obesity is a complex chronic disease associated with serious comorbidities including type 2 diabetes, cardiovascular disease, and certain cancers. Healthcare professionals should maintain open, non-judgemental dialogue with patients about CAM use to ensure safety and optimise treatment outcomes.

In the UK, the regulatory landscape for CAM is varied. Some healthcare professions such as osteopaths and chiropractors are statutorily regulated by the General Osteopathic Council (GOsC) and General Chiropractic Council (GCC), whilst many other CAM practitioners operate under voluntary registers, some of which are accredited by the Professional Standards Authority (PSA). Herbal medicines may be registered under the Medicines and Healthcare products Regulatory Agency (MHRA) Traditional Herbal Registration (THR) scheme, indicated by a THR logo on the product. However, most dietary supplements marketed for weight loss are regulated as foods by the Food Standards Agency (FSA), not as medicines, and are not subject to the same stringent pre-market testing as licensed medicines. Health claims on such products are restricted under UK and retained EU law.

Types of Complementary and Alternative Medicine for Weight Management

The spectrum of CAM approaches used in obesity treatment is remarkably broad, encompassing biological, mind-body, and manipulative therapies. Understanding these categories helps both patients and clinicians navigate this complex landscape.

Herbal and dietary supplements represent the most commonly used CAM modality for weight loss. Products containing green tea extract, garcinia cambogia, conjugated linoleic acid (CLA), and chromium are widely marketed, often with claims of enhanced metabolism or appetite suppression. Various 'detox' formulations are also promoted; however, these lack scientific evidence and are not medically recommended. The quality, purity, and actual content of dietary supplements can vary considerably, as they are regulated as foods rather than medicines and are not subject to the same rigorous testing as licensed pharmaceuticals. Patients should be aware that multi-herb products carry risks of contamination and herb–drug interactions, and should always discuss supplement use with their GP or pharmacist before starting.

Mind-body interventions include practices such as mindfulness-based eating, meditation, yoga, and hypnotherapy. These approaches typically focus on addressing psychological factors contributing to obesity, such as emotional eating, stress-related food consumption, and poor awareness of hunger and satiety cues. Mindfulness-based interventions have gained some traction in weight management services due to emerging evidence for their role in reducing binge eating behaviours, though they are not specifically endorsed by NICE as standalone treatments for weight loss.

Traditional medicine systems such as traditional Chinese medicine (TCM) and Ayurveda offer holistic approaches to weight management, often combining herbal preparations with dietary advice, acupuncture, and lifestyle modifications. Acupuncture specifically has been investigated for its potential effects on appetite regulation and metabolic function, though evidence for meaningful weight loss remains limited.

Manual therapies including massage and certain forms of bodywork are sometimes promoted for weight loss, though evidence for direct effects on body composition is limited. These may offer indirect benefits through stress reduction and improved body awareness.

It is important to note that meal replacement products, whilst sometimes confused with CAM, are regulated foods for weight control in the UK and may form part of evidence-based structured weight management programmes. They are not classified as complementary or alternative medicine.

Evidence for CAM Approaches in Obesity: What Research Shows

The evidence base for CAM in obesity treatment varies considerably across different modalities, with most interventions lacking the robust, high-quality evidence required to support routine clinical use. Systematic reviews and meta-analyses provide the most reliable assessment of effectiveness. Importantly, NICE does not currently recommend any CAM therapy for routine obesity treatment.

Herbal supplements have been extensively studied, yet results remain largely disappointing. Green tea extract (containing catechins and caffeine) shows modest effects on weight loss in some trials—typically 1–2 kg greater than placebo over 12 weeks according to meta-analyses—but effects are small and clinical significance is questionable. Garcinia cambogia, despite widespread marketing, has not demonstrated consistent benefits in well-designed trials. A Cochrane review of various herbal preparations concluded that evidence is insufficient to recommend any specific product for weight management. Furthermore, the quality of available studies is often poor, with small sample sizes, short duration, and inadequate reporting of adverse effects.

Acupuncture has been investigated in numerous trials, with meta-analyses suggesting small reductions in body weight and BMI compared to sham acupuncture or no treatment. However, methodological limitations—including difficulty in achieving adequate blinding and high risk of bias—mean these findings should be interpreted cautiously. There is no established link between acupuncture and sustained, clinically meaningful weight loss.

Mindfulness-based interventions show more promise, particularly for individuals with binge eating disorder or emotional eating patterns. Systematic reviews indicate these approaches can reduce binge eating frequency and improve eating behaviours, though effects on actual weight loss are modest and variable. NICE guidance on obesity management (CG189) emphasises multicomponent behavioural programmes, including cognitive behavioural therapy (CBT), as part of evidence-based care. Mindfulness techniques may help some individuals but are not specifically endorsed as standalone treatments for weight loss.

Overall, no CAM therapy has demonstrated efficacy comparable to evidence-based conventional treatments such as structured lifestyle modification programmes, approved pharmacotherapy, or bariatric surgery for appropriate candidates. In the UK, NICE-approved pharmacological options for weight management include orlistat (NICE TA664), liraglutide (NICE TA664), semaglutide (NICE TA875), and tirzepatide (NICE TA1026), each with specific eligibility criteria.

Safety Considerations and Potential Risks of CAM for Obesity

Whilst many people perceive CAM therapies as inherently safe due to their 'natural' origins, this assumption is not always justified. Several important safety considerations warrant careful attention from both patients and healthcare professionals.

Herbal and dietary supplements pose multiple risks. Firstly, these products are not subject to the same pre-market safety and efficacy testing as licensed medicines. Contamination with undeclared pharmaceutical ingredients (including banned substances such as sibutramine), heavy metals, or other adulterants has been documented in weight loss supplements available in the UK market. The MHRA regularly issues safety alerts regarding such products, particularly those purchased online from unlicensed sources. Secondly, herbal preparations can cause direct adverse effects—green tea extract has been associated with hepatotoxicity (liver injury) in some cases, as highlighted by the European Food Safety Authority (EFSA) in 2018. Patients should stop taking any supplement and seek urgent medical attention if they develop jaundice (yellowing of the skin or eyes), dark urine, severe itching, right upper abdominal pain, or unexplained fatigue. Products containing stimulants may cause cardiovascular effects including tachycardia (rapid heart rate), palpitations, and hypertension (high blood pressure).

Herb–drug interactions represent another significant concern. St John's wort, which some people may take for mood whilst attempting weight loss, is a potent inducer of cytochrome P450 enzymes and can reduce the effectiveness of numerous medications including oral contraceptives, anticoagulants, and antidepressants. Patients taking prescribed medications should always inform their GP or pharmacist about any supplements they are considering.

Special populations: Weight-loss supplements should be avoided during pregnancy and breastfeeding, and in people with liver disease, cardiac conditions, or other significant health problems unless specifically advised by a clinician.

Opportunity cost and delayed treatment constitute perhaps the most serious risk. When individuals pursue unproven CAM therapies instead of evidence-based interventions, they may delay effective treatment for obesity and its complications. This is particularly concerning given that obesity-related conditions such as type 2 diabetes and cardiovascular disease benefit from early, intensive management.

Financial exploitation is also relevant, as many CAM products and services are costly and purchased out-of-pocket. Vulnerable individuals seeking weight loss solutions may spend considerable sums on ineffective treatments.

Reporting adverse effects: If you experience any suspected side effects from a CAM product, you should report them via the MHRA Yellow Card scheme at yellowcard.mhra.gov.uk or through the Yellow Card app. This helps protect others by identifying safety issues.

When to contact your GP: Patients should seek medical advice if they experience any adverse effects from CAM products, if they are considering CAM alongside prescribed medications, or if they have obesity-related health conditions requiring medical management. Seek urgent medical attention if you develop symptoms such as jaundice, severe chest pain, severe palpitations, difficulty breathing, or signs of an allergic reaction.

Purchasing advice: Buy supplements only from reputable UK sources; avoid products making unrealistic claims (such as rapid weight loss without lifestyle change); look for the THR logo on registered herbal medicines; and be particularly cautious of products purchased online from unlicensed sellers.

Integrating CAM with Conventional Obesity Treatment in the UK

The optimal approach to obesity management in the UK follows NICE guidance (CG189), which recommends multicomponent interventions addressing diet, physical activity, and behaviour change. For some patients, carefully selected CAM approaches may complement—but should never replace—these evidence-based strategies.

Clinical assessment and shared decision-making form the foundation of appropriate CAM integration. Healthcare professionals should routinely enquire about CAM use in a non-judgemental manner, as many patients do not volunteer this information. When patients express interest in CAM, clinicians should explore their motivations, provide balanced information about evidence and safety, and work collaboratively to develop a treatment plan that prioritises proven interventions whilst respecting patient preferences where safe to do so.

Mindfulness-based approaches represent the CAM modality with the strongest evidence base and lowest risk profile for potential integration into conventional obesity services. Some local NHS weight management programmes may incorporate mindfulness techniques to address emotional eating and improve adherence to dietary changes. These can be safely combined with dietary advice, physical activity programmes, and pharmacological treatment when indicated. However, it is important to note that mindfulness is not specifically endorsed by NICE as a standalone treatment for weight loss; NICE emphasises multicomponent behavioural programmes including cognitive behavioural therapy (CBT).

Acupuncture is not recommended by NICE for routine weight management. Whilst it may be considered as an adjunct in some specialist settings, patients should understand that evidence for meaningful weight loss is limited, and it should not delay or replace core interventions.

Herbal supplements generally cannot be recommended due to insufficient evidence, safety concerns, and lack of regulation. If patients choose to use such products despite advice, healthcare professionals should document this, counsel on potential risks (including herb–drug interactions), and monitor for adverse effects.

Pharmacological treatment: When lifestyle interventions alone are insufficient, NICE-approved pharmacotherapy options include orlistat (NICE TA664), liraglutide (NICE TA664), semaglutide (NICE TA875), and tirzepatide (NICE TA1026), each with specific eligibility criteria based on BMI, comorbidities, and response to initial treatment. These should be prescribed as part of a comprehensive weight management programme.

Referral pathways in the UK typically involve initial management in primary care, with referral to specialist weight management services (Tier 3) for patients with complex needs or those who have not responded to initial interventions. Tier 4 services provide bariatric surgery for eligible patients meeting NICE criteria, which include BMI thresholds and the presence of obesity-related comorbidities. Decisions about bariatric surgery are made through shared decision-making in multidisciplinary team settings. CAM practitioners are not part of standard NHS obesity care pathways, though some integrated care systems may include complementary therapists within multidisciplinary teams on a local basis.

Patient safety advice: Individuals should inform all healthcare providers about any CAM therapies they are using, purchase supplements only from reputable UK sources, be wary of products making unrealistic claims, look for the THR logo on registered herbal medicines, and prioritise evidence-based treatments recommended by their healthcare team. Sustainable weight management requires long-term lifestyle changes rather than quick fixes. Report any suspected side effects via the MHRA Yellow Card scheme.

Frequently Asked Questions