Catgut Acupuncture for Weight Loss: A Review of Clinical Methodologies

Background: Obesity is a major global health challenge, with its prevalence increasing by more than 50% worldwide between 2000 and 2016. Conventional treatments such as diet, exercise, and surgery often have limitations, including low long-term adherence and associated risks. Within Traditional Chinese Medicine (TCM), obesity is considered a metabolic imbalance linked to a deficiency of the Spleen and stagnation of Qi and Blood. Catgut acupuncture is a minimally in-vasive technique that involves implanting absorbable sutures into acupoints to provide contin-uous, long-lasting stimulation. It has gained attention as a potential adjunctive therapy for weight management, with studies suggesting it works by modulating appetite-related hor-mones, improving insulin sensitivity, and regulating lipid metabolism.Objectives: This review aims to summarise the diverse clinical methodologies used in catgut acupuncture for weight loss and to highlight the most commonly used acupoints and their po-tential mechanisms of action.Methods: This paper builds on a prior preliminary systematic review by the authors. It analyses the clinical methodologies of catgut acupuncture used in a selection of randomised controlled trials (RCTs). The review focuses on identifying commonalities in acupoint selection, treatment frequency, and duration across the included studies. The most frequently used acupoints are discussed, along with their proposed physiological mechanisms for promoting weight loss.Results: The analysis of ten studies revealed a wide range of treatment methods, with durations from 6 to 16 weeks and frequencies from once every week to a single implantation for the entire trial. A total of 27 different acupoints were identified, with five points being used most fre-quently: Tianshu (ST25), Zhongwan (CV12), Zusanli (ST36), Fenglong (ST40), and Shuifen (CV9). The combination of ST25 and CV12 was notably used in seven studies. Mechanistically, stimu-lating ST25 is thought to influence gastrointestinal function, enteric nervous system activity, and anti-inflammatory responses. CV12 stimulation has been shown to regulate gastric motility, in-fluence the vagus nerve, and modulate hormones such as leptin and ghrelin.Conclusions: Catgut acupuncture shows potential as an effective adjunctive therapy for weight loss, as evidenced by its consistent ability to improve weight-related outcomes across various studies. The combination of ST25 and CV12 appears to be a core component of the treatment protocol for weight loss. However, further large-scale, well-designed RCTs with long-term fol-low-up are necessary to confirm the durability of its effects and to establish best-practice guide-lines for clinical integration.