From Mechanisms to Applications: A New Perspective on the Clinical Implementation of Acupuncture-Induced Weight Loss via Eating Behavior Regulation

Aberrant eating behavior constitutes a critical bottleneck in both the development of obesity and the maintenance of weight loss. This study focused on the role of acupuncture in regulating eating behavior for weight loss. Most studies have focused on the regulation of body weight or body mass index but have overlooked the role of eating behaviors. As a non-pharmacological weight-loss intervention, the multitarget advantage of acupuncture requires a systematic analysis from the perspective of eating. This review focused on the novel perspective that the core mechanism of acupuncture for weight loss relies on the synergy of multiple pathways involving the central nervous system, gut microbiota, and vagus nerve. The central mechanism of acupuncture for weight loss may lie in restoring the imbalance between the neuropeptide Y/agouti-related protein and pro-opiomelanocortin neurons in the hypothalamic arcuate nucleus, as well as improving the function of the prefrontal-limbic system, thereby inhibiting emotional eating. At the peripheral level, acupuncture may maintain leptin–ghrelin homeostasis, inhibit tumor necrosis factor-alpha- or interleukin 6-mediated inflammation, and affect intestinal barrier repair and reconstruction of eating signaling pathways. To address the limitations of current studies, such as the lack of functional magnetic resonance imaging or positron emission tomography neuroimaging evidence, small sample sizes, short follow-up durations, and non-individualized protocols, this review proposes integrated research strategies, including incorporating eating behavior assessment scales, utilizing multi-omics to identify core targets, and conducting multicenter, large-sample, randomized controlled trials. These solutions aim to advance acupuncture from an empirical therapy to precise management, thereby providing novel strategies for obesity prevention and treatment that integrate mechanistic innovations with clinical translational value. Graphical Abstract: https://links.lww.com/AHM/A236