New perspective on acupuncture treatment for obesity: mechanisms in the brain based on multidimensional neural...

Obesity, characterized by pathologic adipose accumulation resulting from an imbalance between energy intake and expenditure, is a major global public health burden. Lifestyle interventions are prone to lead to weight regain, whereas pharmacotherapy and bariatric surgery are constrained by adverse effects or postoperative complications, underscoring an urgent need for safe, effective, and durable strategies. Acupuncture/electroacupuncture can reduce body weight and improve metabolic homeostasis, yet the underlying mechanisms involving central neural circuits remain to be elucidated. This review summarizes evidence that acupuncture modulates appetite through coordinated neuroendocrine actions and whole-brain circuit remodeling, including reprogramming the pro-opiomelanocortin (POMC)/agouti-related protein (AgRP) homeostatic axis and ameliorating leptin resistance; regulating the ventral tegmental area (VTA)-nucleus accumbens (NAc)-prefrontal cortex (PFC) dopaminergic reward pathway to suppress reward-driven feeding; attenuating hyperactivation of the hypothalamic-pituitary-adrenal (HPA) axis and influencing limbic circuitry to relieve stress-induced binge eating; and strengthening prefrontal-hippocampal network connectivity to enhance executive control. Future directions include integrating whole-brain imaging, dynamic monitoring of neurotransmitters and hormones, and causal circuit interrogation to advance efficacy prediction and optimization of individualized protocols.