Hijama, or wet cupping therapy, is a traditional complementary medicine practice involving suction cups and small skin incisions to draw blood. Some practitioners claim hijama treatment for obesity can aid weight loss by 'detoxifying' the body or improving metabolism. However, there is no high-quality scientific evidence supporting hijama as an effective obesity treatment, and it is not recommended by NICE or the NHS for weight management. This article examines what hijama involves, reviews the available evidence, discusses safety considerations, and outlines evidence-based NHS treatments for obesity that have demonstrated meaningful clinical benefits.

What Is Hijama and How Does It Work?

Hijama, also known as wet cupping therapy, is a traditional complementary medicine practice with historical roots in Middle Eastern, Asian, and Islamic medical traditions. The procedure involves placing cups on specific points of the skin to create suction, followed by small superficial incisions through which a small amount of blood is drawn. Practitioners believe this process removes 'harmful substances' from the body and restores balance to bodily systems.

The technique typically begins with dry cupping, where heated cups or mechanical suction devices create negative pressure on the skin surface. This draws blood to the area, causing localised congestion and often leaving circular bruise-like marks. In wet cupping (hijama proper), the practitioner then makes small, shallow cuts using a sterile blade before reapplying the cups to extract small quantities of blood. Session duration and anatomical sites vary between practitioners and are not standardised; a typical session may last 20–30 minutes.

Proponents of hijama suggest it works through several proposed mechanisms: improving blood circulation, stimulating the immune system, removing metabolic waste products, and triggering the body's natural healing responses. Some theories draw on traditional humoral medicine concepts, whilst others attempt to frame the practice within modern physiological understanding. However, it is important to note that these proposed mechanisms are unproven and lack high-quality supporting evidence. The biological basis for any therapeutic effects of hijama remains poorly understood and has not been validated through rigorous scientific research.

In the context of obesity, hijama practitioners may claim the therapy aids weight loss by 'detoxifying' the body, improving metabolism, or addressing hormonal imbalances. Hijama is not recommended by NICE or the NHS for treating obesity, and these claims require careful examination against available clinical evidence, which we explore in the following section.

What Does the Evidence Say About Hijama for Obesity?

The scientific evidence supporting hijama as an effective treatment for obesity is extremely limited and of poor quality. A comprehensive review of the medical literature reveals no high-quality randomised controlled trials (RCTs) specifically examining wet cupping therapy for weight reduction or obesity management. The few studies that exist are typically small-scale, lack proper control groups, have significant methodological flaws, and often originate from regions where the practice is culturally embedded, raising concerns about publication bias. There is no NICE recommendation for hijama for obesity, and no high-quality evidence supporting clinically meaningful weight loss.

Some preliminary research has explored cupping therapy (both dry and wet) for metabolic conditions. A handful of studies have suggested potential effects on blood lipid profiles or inflammatory markers, but these findings are inconsistent, not replicated in larger trials, and do not demonstrate clinically meaningful weight loss. Importantly, none of these studies meet the rigorous standards required for evidence-based guideline developers like the National Institute for Health and Care Excellence (NICE).

Obesity is a complex, multifactorial chronic disease involving genetic, environmental, psychological, and metabolic components. Effective management requires sustained lifestyle modification, and in some cases, pharmacological or surgical intervention. There is no established or biologically plausible, evidence-supported mechanism by which removing small amounts of blood through superficial skin incisions would meaningfully impact energy balance, adipose tissue metabolism, or the neuroendocrine systems regulating body weight. Claims that hijama 'detoxifies' the body or 'rebalances metabolism' lack scientific foundation—the human body possesses highly efficient detoxification systems (liver, kidneys) that function independently of cupping therapy.

Patients considering hijama for obesity should be aware that relying on unproven treatments may delay access to evidence-based interventions that have demonstrated efficacy in clinical trials and real-world settings. Weight management requires a comprehensive, individualised approach supported by healthcare professionals, as outlined in NICE guidance (CG189: Obesity: identification, assessment and management).

Safety Considerations and Potential Risks of Hijama

Whilst hijama is generally considered low-risk when performed by trained practitioners using sterile equipment, it is not without potential complications. The procedure involves breaking the skin barrier, which inherently carries infection risk. Reported adverse events include:

• Skin infections (bacterial or, rarely, viral) at incision sites

• Scarring and keloid formation, particularly in susceptible individuals

• Bruising, pain, and skin discolouration that may persist for several weeks

• Burns from heated cups if not applied carefully

• Anaemia if performed too frequently or if excessive blood is removed

• Vasovagal reactions (fainting, dizziness) during or after the procedure

• Transmission of blood-borne infections if equipment is not properly sterilised

• Delayed wound healing in immunosuppressed individuals or those with poor wound healing capacity

In the UK, hijama practitioners are not regulated by statutory healthcare bodies, meaning there is no mandatory training standard, registration requirement, or professional oversight comparable to that for doctors, nurses, or physiotherapists. However, many local authorities require 'special treatments' licensing for procedures involving skin piercing, which sets hygiene and infection control standards. Patients should verify that any practitioner holds appropriate local authority licensing, uses single-use sterile equipment, and follows robust infection control procedures.

Certain individuals should avoid hijama entirely, including those taking anticoagulant medications (warfarin, direct oral anticoagulants), people with bleeding disorders, pregnant women, individuals with active skin infections, those with severe anaemia, and immunosuppressed patients. People with diabetes require particular caution due to impaired wound healing and increased infection risk.

Seek urgent medical care if you experience signs of infection (increasing pain, spreading redness, pus, fever), persistent or heavy bleeding, fainting that does not resolve quickly, or any other concerning symptoms after hijama. You can report suspected side effects from medicines, vaccines, or medical devices to the MHRA Yellow Card Scheme at yellowcard.mhra.gov.uk or via the Yellow Card app; for complications after hijama, seek medical help from your GP or NHS 111.

From a patient safety perspective, it is crucial to recognise that hijama is not a substitute for evidence-based medical care. Individuals with obesity should consult their GP or a specialist weight management service rather than relying on complementary therapies lacking robust efficacy data. If patients choose to pursue hijama alongside conventional treatment, they should inform their healthcare provider to ensure coordinated, safe care and to monitor for potential complications or interactions with prescribed treatments.

NHS-Recommended Treatments for Obesity in the UK

The NHS follows NICE guidelines (CG189: Obesity: identification, assessment and management) for obesity management, which recommend a tiered, evidence-based approach tailored to individual circumstances. These interventions have been rigorously evaluated through clinical trials and have demonstrated meaningful, sustained health benefits.

Tier 1: Population-level prevention focuses on public health measures to reduce obesity risk across communities.

Tier 2: Lifestyle modification and community programmes form the foundation of individual obesity treatment. This includes:

• Dietary changes: Reducing calorie intake through balanced, sustainable eating patterns rather than restrictive fad diets. Referral to NHS-commissioned weight management programmes or registered dietitians may be appropriate.

• Physical activity: Gradual increase to at least 150 minutes of moderate-intensity activity weekly, with additional strength training where possible.

• Behavioural support: Addressing psychological factors, eating behaviours, and barriers to change through structured programmes or psychological therapy.

Tier 3: Specialist weight management services provide multidisciplinary input for complex cases, including psychological assessment, management of obesity-related complications, and consideration for pharmacological intervention. NICE-approved medications include:

• Orlistat (a lipase inhibitor that reduces fat absorption): recommended for adults with BMI ≥30 kg/m² or ≥28 kg/m² with risk factors such as type 2 diabetes or hypertension, as part of an overall plan for managing obesity (see EMC SmPC for Xenical).

• Semaglutide 2.4 mg (Wegovy, a GLP-1 receptor agonist): recommended within specialist weight management services for adults with at least one weight-related comorbidity and initial BMI ≥35 kg/m² (or ≥32.5 kg/m² for some minority ethnic groups), as outlined in NICE TA875. Treatment is time-limited and requires regular review.

• Liraglutide 3.0 mg (Saxenda): available under restricted criteria as defined in NICE TA664, typically within specialist services.

Availability of these treatments follows NICE guidance and funding mandates, though practical access may depend on local service capacity and medicine supply.

Tier 4: Bariatric surgery (gastric bypass, sleeve gastrectomy) is recommended for people with BMI ≥40 kg/m² or ≥35 kg/m² with significant obesity-related comorbidities (such as type 2 diabetes or high blood pressure) who have tried other interventions. NICE also recommends considering surgery at lower BMI thresholds (30–34.9 kg/m²) for adults with recent-onset type 2 diabetes, and lower thresholds apply for some minority ethnic groups who are at equivalent risk at lower BMI. Surgery has the strongest evidence for substantial, sustained weight loss and improvement in conditions like type 2 diabetes and cardiovascular risk.

Patients should contact their GP to access these evidence-based services. Initial assessment typically includes measurement of BMI, waist circumference, and evaluation of obesity-related complications (hypertension, type 2 diabetes, sleep apnoea, osteoarthritis). The GP can then refer to appropriate NHS services, which may include community weight management programmes (Tier 2), specialist weight management clinics (Tier 3), or surgical assessment (Tier 4) depending on individual needs and local service availability. Further information is available on the NHS obesity treatment and weight-loss medicines pages.

Frequently Asked Questions