Acupuncture-induced fat thickness reduction in different body regions: A case report and review of literature

Abstract

BACKGROUND

Obesity leads to excessive fat accumulation and autonomic nervous dysfunction. Acupuncture has shown promising therapeutic effects for weight reduction; however, its effects on different fat depots remain unclear. This study reports a case of a male obese patient who exhibited significant reduction of adipose tissue in multiple body regions following acupuncture treatment. Based on the distinct distribution patterns of fat loss and their potential correlation with local neuro-endocrine systems, we further explore the possible mechanisms underlying site-specific fat reduction induced by acupuncture.

CASE SUMMARY

A 35-year-old male [height 180 cm, weight 122.5 kg, body mass index (BMI) 37.8 kg/m²] underwent acupuncture treatment three times per week for eight weeks (24 sessions). The acupuncture parameters were as follows: Acupoints: Baihui (GV20), Shenting (GV24), Yintang (EX-HN3), Shuifen (CV9), Tianshu (ST25, bilateral), Shuidao (ST28, bilateral), Sanyinjiao (SP6, bilateral), Zusanli (ST36, bilateral), Yinlingquan (SP9, bilateral); frequency: Acupuncture was administered three times per week (on Tuesday, Thursday, and Saturday mornings) over a continuous period of eight weeks; duration: 30 minutes per session. After treatment, his body weight decreased by 6.0 kg, waist circumference by 14.5 cm, and BMI by 1.8. Ultrasonography revealed significant reductions in both subcutaneous fat (subscapular and right abdominal regions) and visceral fat (preperitoneal, perirenal, and intra-abdominal regions). These findings suggest that acupuncture may effectively reduce fat thickness across multiple regions and improve overall fat distribution. This phenomenon may be attributable to differences in the sensitivity of regional adipose tissues to the same acupuncture stimulus, likely due to variations in their structural composition, sympathetic innervation density, and β3-adrenergic receptor expression.

CONCLUSION

This case suggests that aupuncture treatment significantly reduced both subcutaneous and visceral fat thickness in patients with obesity, demonstrating its important role in modulating systemic fat distribution, particularly in decreasing visceral adiposity.

Key Words: Obesity; Acupuncture treatment; Visceral fat; Metabolic risk factor; Case report

Core Tip: This study reports a case of a 35-year-old male (180 cm, 122.5 kg, body mass index 37.8 kg/m², waist circumference 125.4 cm) who received thrice-weekly acupuncture for 8 weeks. Ultrasonography showed significant reductions in his subcutaneous and visceral fat, with visceral fat loss being more pronounced. Waist circumference, visceral fat thickness, Chinese visceral adiposity index and visceral fat volume all decreased notably. This case suggests that acupuncture not only induces weight loss but also preferentially reduces harmful visceral fat, directly targeting a key risk factor for metabolic diseases.

INTRODUCTION

Obesity and its associated metabolic syndrome are major global public health challenges. The “World Obesity Report 2025” proposed by the Global Obsity Observatory indicates that by 2030, more than 2.9 billion adults worldwide will be in a state of high body mass index (BMI), among which 1.1 billion (487 million for men) Women (643 million) will reach obesity levels (BMI ≥ 30 kg/m²). Since 2010, the proportion of adult population with high BMI (BMI ≥ 25 kg/m²) in China has been on the rise. By 2025, the proportion of adult population with high BMI will be 41% and the prevalence of obesity will be 9%. It is estimated that by 2030, the number of adult population with high BMI in China will reach 5.1504 million[1]. Pathophysiological changes caused by obesity may lead to excessive accumulation of adipose tissue under the skin, in internal organs (mainly located in the abdominal cavity), and in non-adipose tissues (such as the liver, heart, and pancreas) at the pericardium and epicardium[2]. Relevant studies have shown that excessive accumulation of visceral fat and ectopic fat can increase the incidence of cardiovascular diseases such as coronary heart disease, heart failure, and arrhythmia[3]. In addition, obesity will lead to a systemic chronic low-grade inflammatory state, which can trigger neuroinflammation in the central nervous system, especially in the hypothalamus[4], thereby causing dysfunction of the autonomic nervous system. This process has been confirmed in studies on animals such as rats and humans. For instance, a high-fat diet and obesity can directly lead to significant inflammatory markers and glial hyperplasia in the arcuate nucleus (ARC) of the hypothalamus and the adjacent median eminence in both human and rodent models[5]. Fat accumulation mainly causes neuroinflammation through two pathways. One is the dysfunction of the blood-brain barrier. Pro-inflammatory cytokines released by adipose tissue [such as tumor necrosis factor-alpha (TNF-α), interleukin-1β, and interleukin-6 (IL-6)] can disrupt the integrity of the blood-brain barrier, allowing peripheral inflammatory cytokines to enter the brain parenchyma, activate microglia and astrocytes, and further release pro-inflammatory factors. Secondly, a high-fat diet can directly activate microglia by increasing fatty acids, and this activation depends on the Toll-like receptor (TLR) - nuclear factor-κB (NF-κB) pathway, which promotes the expression of pro-inflammatory cytokines[6].

Acupuncture has been proven to have significant therapeutic effects in weight loss. It can regulate the hypothalamus, sympathetic and parasympathetic nerve activities, obesization-related hormones [leptin, ghrelin, insulin and cholecystokinin (CCK)], the brain-gut axis, inflammatory states, fat tissue browing, muscle blood flow, hypoxia and reactive oxygen species. This thereby affects metabolism, eating behavior, motivation, cognition and the reward system[7]. Its physiological mechanism includes that acupuncture affects the hypothalamic-pituitary-adrenal axis by regulating the expression of neuropeptides such as neuropeptides such as neuropeptide Y, agouti-related peptide, pro-opiomelanocortin, and alpha-melanocyte-stimulating hormone in ARC[8]; In the peripheral nervous system, acupuncture can enhance the excitability of vagus nerve afferent by stimulating the area innervated by the auricular branch of the vagus nerve, thereby transmitting gastrointestinal satiety signals (such as CCK) to the central nervous system. Meanwhile, acupuncture can increase the level of serum glucagon-like peptide-1. This hormone can not only act indirectly on the nucleus solitarius of the brainstem through vagus nerve input signals, but also directly act on the appetite regulation center of the hypothalamus, thereby inhibiting appetite, promoting the brown formation of white fat, and improving insulin resistance[9].

Furthermore, acupuncture improves metabolic balance and promotes weight loss by modulating the secretion and sensitivity of four key hormones: Leptin, ghrelin, insulin, and CCK. Leptin, secreted primarily by adipose tissue, regulates energy homeostasis. Obesity may be associated with leptin deficiency (type 1) or leptin resistance (type 2). Animal studies indicate that acupuncture effectively regulates plasma leptin levels, notably reducing elevated leptin and ameliorating leptin resistance in type 2 obesity[10,11]. Ghrelin, which exerts opposite physiological effects to leptin, shows increased plasma levels in obese patients following acupuncture alongside reduced BMI[7]. Insulin promotes lipogenesis and inhibits lipolysis via pathways such as pathways such as phosphoinositide 3-kinase (PI3K)/protein kinase B (Akt). Clinical studies report that acupuncture at points including Zhongwan (CV 12), Quchi (LI 11), and Zusanli (ST 36) lowers body weight, fasting insulin, and the homeostasis model assessment of insulin resistance in individuals with simple obesity[12]. CCK, secreted by gastrointestinal I cells, enhances satiety and reduces food intake. Acupuncture at Fenglong (ST 40), Zhongwan (CV 12), Guanyuan (CV 4), and Zusanli (ST 36) can potentiate CCK activity, thereby decreasing appetite and body weight while improving insulin sensitivity[13]. Notably, acupuncture-induced increases in CCK appear independent of specific point selection, as both abdominal and lower extremity points significantly stimulate its serum expression[14] This study summarizes the characteristics of weightloss effects and potential underlying mechanisms of acupuncture points at distinct anatomical locations (Table 1).

Table 1 Characteristics of weight-reduction effects and potential mechanisms of acupuncture points at different anatomical sites.

Anatomical region	Acupoint	Observed effect	Proposed mechanism	Ref.
Head and neck	Baihui (GV20) Yintang (EX-HN3)	The integrated acupuncture plan for Baihui, Yintang and other acupoints has a positive impact on reducing depression and anxiety scores. Positive improvements have also been observed in obesity indicators such as weight, BMI and waist circumference, and the therapeutic effect is sustainable[32]	Acupuncture at Baihui and Yintang may improve mood and promote weight loss by regulating the function of the HPA axis[33], reducing related pro-inflammatory cytokines to improve neuroinflammation[34], and regulating leptin/insulin imbalance[35]	[32-35]
	Shenting (GV24)	In combination with Baihui and Yintang for acupuncture, there were significant improvements in weight, BMI, waist circumference, anxiety, depression and TCM symptoms, and the marked efficiency was higher than that of acupuncture at Tianshu and Zhongwan points alone[36]		[36]
Chest and abdomen	Shuifen (CV9); Shuidao (ST28)	Shuifen (CV9) and Shuidao (ST28) serve as key components of a compound acupoint prescription. They can synergize with other acupoints to exert effects such as promoting diuresis, reducing edema, and regulating body fluid metabolism, thereby contributing to weight loss[37]	Acupuncture at Shuifen (CV9) and Shuidao (ST28) has been shown to significantly reduce abnormally elevated serum immunoglobulin (IgM, IgG) levels and upregulate the expression of aquaporins AQP2 and AQP3 in renal tissue in model rats, providing mechanistic support for its diuretic and weight-loss effects[37]	[37]
	Tianshu (ST25)	Tianshu (ST25) comprehensively improves the intestinal microenvironment by modulating enteric glial cell autophagy, restoring intestinal barrier integrity, and suppressing local inflammation. This directly optimizes intestinal motility and mucosal barrier function, indirectly supporting the weight-loss process[38-40]	The mechanism of Tianshu (ST25) involves multi-target synergy. Network pharmacology analysis suggests that interventions focusing on this acupoint may regulate key molecules such as NFKB1, IL6, MyD88, TLR4, and TNF, thereby modulating systemic inflammatory responses and immune function balance[38]	[38-40]
	Zhongwan (CV12)	Stimulation of Zhongwan (CV12) effectively ameliorates gastrointestinal motility disorders and regulates gastrointestinal secretion, establishing a functional gastrointestinal foundation for weight loss	Electroacupuncture stimulation at acupoints including Zhongwan (CV12) and Tianshu (ST25) may reduce food intake and ultimately lead to weight loss by inhibiting hypothalamic inflammation and restoring the normal function of POMC neurons[41]	[41,42]
	Guanyuan (CV4)	Electroacupuncture stimulation at Guanyuan (CV4) effectively promotes gastrointestinal motility and alleviates systemic and local inflammatory responses, creating a favorable anti-inflammatory microenvironment for weight loss[43]		[41,43]
Back	Pishu (BL20)	It has the functions of regulating sugar and lipid metabolism, improving insulin resistance and enhancing insulin sensitivity. Lower blood sugar, alleviate chronic inflammatory responses in the islets, and improve the dedifferentiation of pancreatic β cells; Improve insulin resistance in the liver	Inhibit the expression and activation of MST1, reduce β-cell apoptosis and enhance insulin synthesis, regulate the expression of ZAG and GLUT4 in peripheral tissues, inhibit the pancreatic NF-κB pathway, and activate the Akt/FoxO1 signaling pathway to improve metabolism and inflammation	[44]
	Yishu (BL20)	Acupuncture at the Yishu point has the effect of reducing FBG. It can significantly increase the ISI and significantly reduce the levels of serum TG and LDL-C	Selectively reduce CORT, inhibit gluconeogenesis, and improve insulin resistance; Moreover, acupuncture at the Pancreatic Shu point can down-regulate the secretion levels of CRH and CORT in the HPA axis through subcortical centers such as the hypothalamus
Upper limb	Quchi (LI11)	Acupuncture at LI11 can enhance glucose sensing and promote energy expenditure, thereby reducing body weight by increasing caloric consumption	Acupuncture at LI11 can upregulate the expression of pAMPKα in the pancreas, thereby increasing energy expenditure and achieving the goal of treating obesity	[24]
Lower limb	Sanyinjiao (SP6)	Acupuncture at SP6 can restore the physiological function of energy expenditure in mice, while also suppressing appetite, regulating glucose homeostasis, and modulating immune responses, thereby achieving the goal of weight loss	SP6 exerts its effects by restoring microbial balance, enhancing SCFA production, activating vagal afferents, and influencing neuroendocrine feedback loops, positions it as a promising candidate for integrative obesity management. Electroacupuncture at ST36 can also modulate the gut microbiota, increase the expression of c-Fos in the central nervous system and hypothalamic regions, regulate the activation of neural circuits, suppress appetite, and ameliorate metabolic disorders induced by a high-fat diet[45]. Electroacupuncture at ST36 can also modulate gastric motility by vagal and sympathetic reflexes	[45]
	Zusanli (ST36)	Acupuncture at ST36 suppresses appetite and reduces nutrient intake. It also alleviates metabolic disorders associated with obesity, thereby increasing energy expenditure and achieving multi-faceted weight loss effects		[45-47]
	Yinlingquan (SP9)	Acupuncture at SP9 regulates fluid metabolism, alleviates edema associated with obesity, and thereby assists in the treatment of obesity	This effect may be achieved by regulating renal blood flow or related hormones (such as ADH) to promote water excretion
	Fenglong (ST40)	Acupuncture at the ST40 acupoint can suppress appetite, regulate metabolism, and consequently achieve weight loss	It improves insulin resistance, promotes processes like glucose oxidation and conversion, and finally boosts energy use

BMI: Body mass index; HPA: Hypothalamic-pituitary-adrenal axis; TCM: Traditional Chinese Medicine; IgM: Immunoglobulin M; IgG: Immunoglobulin G; AQP2: Aquaporin 2; AQP3: Aquaporin 3; NFKB1: Nuclear factor kappa B subunit 1; IL6: Interleukin 6; MyD88: Myeloid differentiation primary response 88; TLR4: Toll-like receptor 4; TNF: Tumor necrosis factor; POMC: Proopiomelanocortin; MST1: Mammalian Ste20-like kinase 1; ZAG: Zinc-alpha2-glycoprotein; GLUT4: Glucose transporter type 4; NF-κB: Nuclear factor kappa-light-chain-enhancer of activated B cells; Akt/FoxO1: Protein kinase B/forkhead box O1; FBG: Fasting blood glucose; ISI: Insulin sensitivity index; TG: Triglycerides; LDL-C: Low-density lipoprotein cholesterol; CORT: Corticosterone; CRH: Corticotropin-releasing hormone; pAMPKα: Phosphorylated AMP-activated protein kinase alpha; SCFA: Short-chain fatty acids; c-Fos: Fos proto-oncogene; ADH: Antidiuretic hormone.

Current evidence regarding acupuncture’s hypothalamic regulation derives largely from animal studies, in which acupoint localization and area differ from humans, factors critical to therapeutic outcome. Thus, whether acupuncture differentially affects regional adipose tissue and through what mechanisms remains unclear[7]. In a relevant clinical observation, eight weeks of acupuncture treatment in one patient led to reductions in both subcutaneous and visceral fat thickness (VFT) measured by ultrasound, with a more pronounced decrease in visceral fat. This case suggests that acupuncture may exert site-specific effects on adipose tissue.

CASE PRESENTATION

Chief complaints

A 35-year-old male presented with a 3-year history of progressive weight gain accompanied by dyslipidemia and obesity-related symptoms.

History of present illness

The patient reported gradual weight increase over the past three years, attributed to chronic excessive caloric intake, reduced physical activity, and irregular sleep patterns. His weight peaked at 122.5 kg. Previous self-directed attempts at exercise and dietary restriction failed to achieve significant weight loss. Associated symptoms included mild fatigue, hyperhidrosis, and exertional dyspnea. No other significant discomfort was reported.

History of past illness

No history of hypertension, diabetes mellitus, or cardiovascular disease. Diagnosed with fatty liver disease one year prior. No history of surgical interventions or significant trauma.

Personal and family history

Married, college-educated, office worker. Long-term history of tobacco smoking and alcohol consumption. No significant family history of heritable disorders.

Physical examination

Height: 180 cm; weight: 122.5 kg; BMI: 37.8 kg/m². Body fat percentage: 41.5%. Waist circumference: 125.4 cm; hip circumference: 123.0 cm; waist-to-hip ratio: 0.97. Vital signs were stable. Physical examination revealed abdominal distension and substantial subcutaneous adipose tissue deposition.

Laboratory examinations

Pre-treatment blood tests indicated dyslipidemia: Triglycerides 1.08 mmol/L, high-density lipoprotein cholesterol (HDL-C) 1.16 mmol/L, low-density lipoprotein cholesterol (LDL-C) 3.84 mmol/L, total cholesterol (TC) 5.60 mmol/L.

Local laboratory reference ranges: Triglycerides < 1.7 mmol/L; HDL-C ≥ 1.2 mmol/L; LDL-C < 3.4 mmol/L; TC < 5.2 mmol/L.

Imaging examinations

Abdominal ultrasonography revealed significant visceral fat accumulation, with key measurements as follows: Subcutaneous fat thickness at the right inferior scapular angle (representing trunk subcutaneous fat): 22.75 mm; subcutaneous fat thickness (SCFT) at the right triceps brachii (representing limb subcutaneous fat): 11.21 mm; right periumbilical SCFT (minimum thickness between linea alba and fat-skin interface): 44.33 mm; right perirenal posterior fat thickness (measured in the perirenal space posterior to the right kidney): 30.76 mm; VFT (measured 1 cm above the umbilicus, from the medial border of the rectus abdominis muscle to the anterior wall of the abdominal aorta): 118.29 mm.

FINAL DIAGNOSIS

Based on the clinical history and investigations, the final diagnosis was obesity with metabolic disorder (mixed dyslipidemia) and fatty liver disease.

TREATMENT

The patient underwent a standardized acupuncture regimen for 8 weeks, with three sessions per week.

Acupuncture protocol

Acupoints: Baihui (GV20), Shenting (GV24), Yintang (EX-HN3), Shuifen (CV9), Tianshu (ST25, bilateral), Shuidao (ST28, bilateral), Sanyinjiao (SP6, bilateral), Zusanli (ST36, bilateral), Yinlingquan (SP9, bilateral). Point locations were determined according to the National Standard of the People’s Republic of China: Location of Acupoints (GB12346-90).

Procedure: With the patient in a supine position, standard skin disinfection was performed. Disposable sterile acupuncture needles (0.30 mm × 40 mm) were used. For Baihui, Shenting, and Yintang, needles were inserted subcutaneously towards the direction of the governor vessel at a 15-degree angle. All other points were needled perpendicularly to a depth of 10-20 mm. Upon achieving the de qi sensation, needles were retained for 30 minutes.

Practitioner qualification: All treatments were administered by the same licensed acupuncture physician with over ten years of clinical experience.

OUTCOME AND FOLLOW-UP

The patient commenced regular acupuncture treatment on March 15, 2025. Re-evaluation after 8 weeks (May 10, 2025) demonstrated significant improvements: Body weight decreased from 122.5 kg to 116.5 kg, waist circumference reduced from 125.4 cm to 110.9 cm, and body fat percentage declined from 41.5% to 39.3%. Concomitant improvements were observed across anthropometric, metabolic, and imaging parameters (Table 2). Specifically, serum levels of total cholesterol and LDL-C decreased. Abdominal ultrasonography objectively demonstrated favorable changes in fat distribution.

Table 2 Comparison of key patient metrics before and after treatment.

Metric	Pre-treatment (March 15, 2025)	Post-treatment (May 10, 2025)
Body weight (kg)	122.5	116.5
Waist circumference (cm)	125.4	110.9
Body fat percentage (%)	41.5	39.3
Visceral fat thickness (VFT, mm)	118.29	100.09
Abdominal subcutaneous fat thickness (SCFT, mm)	44.33	32.01
Total cholesterol (mmol/L)	5.60	5.53
Low-density lipoprotein cholesterol (mmol/L)	3.84	3.53
High-density lipoprotein cholesterol (mmol/L)	1.16	1.31
Chinese visceral adiposity index	239.4	181.0
Visceral adipose tissue volume (cm³)	281.7	204.0

Chinese visceral adiposity index (CVAI) calculation formula: Male: CVAI = -267.93 + 0.68 × age + 0.03 × body mass index (BMI) + 4.00 × waist circumference + 22.00 × Log₁₀ (triglycerides) - 16.32 × HDL-C. Female: CVAI = -187.32 + 1.71 × age + 4.23 × BMI + 1.12 × waist circumference + 39.76 × Log₁₀ (triglycerides) - 11.66 × HDL-C. Visceral adipose tissue (VAT) calculation formula: VAT = -9.008 + 1.191 × [distance from inner abdominal muscle surface to splenic vein (mm)] + 0.987 × [distance from inner abdominal muscle surface to posterior wall of abdominal aorta at umbilicus (mm)] + 3.644 × [thickness of fat layer posterior to right kidney (mm)]. SCFT: Subcutaneous fat thickness.

VFT decreased from 118.29 mm to 100.09 mm (Figure 1A), and the right periumbilical SCFT reduced from 44.33 mm to 32.01 mm (Figure 1B). Subjectively, the patient reported increased energy levels, reduced appetite, and significant alleviation of hyperhidrosis and exertional dyspnea.

Figure 1 Ultrasound images. A: Comparative ultrasound images of visceral fat thickness before and after treatment. Ultrasound measurements show a reduction in visceral fat thickness from 118.29 mm pre-treatment (upper image) to 100.09 mm post-treatment (lower image); B: Comparative ultrasound images of right paraumbilical subcutaneous fat thickness before and after treatment. Ultrasound measurements show a reduction in subcutaneous fat thickness from 44.33 mm pre-treatment (upper image) to 32.01 mm post-treatment (lower image).

Ultrasound measurements show a reduction in SCFT from 44.33 mm pre-treatment (upper image) to 32.01 mm post-treatment (lower image).

DISCUSSION

The effects of acupuncture for weight loss can be categorized into two aspects: Systemic regulation and local adipose tissue remodeling. Systemic effects are primarily manifested through multi-target regulation at both central and peripheral levels, comprehensively improving energy metabolism, neuroendocrine function, and inflammatory status, ultimately leading to overall weight reduction[15]. Local effects are reflected in its differential impact on adipose tissue in various depots, particularly subcutaneous vs visceral fat. In this case, after 8 weeks of treatment, the patient exhibited significant reductions in both body weight and waist circumference. Ultrasonography revealed a particularly prominent decrease in visceral fat. This suggests that while acupuncture exerts an overall weight-loss effect, it may preferentially or more potently target visceral adipose tissue (VAT). This indicates that the systemic effects of acupuncture (e.g., appetite suppression, metabolic improvement) form the foundation for local fat reduction, while the differential responsiveness of local fat depots, especially VAT, to acupuncture intervention is key to modulating body fat distribution.

The results of this case show that visceral fat is more sensitive to acupuncture. Previous studies indicate that visceral adipose tissue exhibits greater percentage sensitivity to weight loss compared to subcutaneous adipose tissue (SAT)[16]. Furthermore, all forms of weight loss exert a greater impact on VAT than on SAT[17]. Although these cited studies did not specifically include acupuncture, they suggest that due to differences in composition and structure, fat depots may indeed vary in their sensitivity to the same mechanism of action. From a molecular perspective, this differential sensitivity may be attributed to the higher density of β3-adrenergic receptors (β3-AR) in visceral fat, which enhances its responsiveness to sympathetic nervous system output. Acupuncture has been shown to upregulate β3-AR expression and increase local norepinephrine (NE) release, thereby activating the cyclic adenosine monophosphate (cAMP)-protein kinase A (PKA)-hormone-sensitive lipase (HSL) signaling axis and promoting lipolysis preferentially in visceral depots[18-20]. The differential local response to acupuncture may be related to the following aspects. Before examining these aspects, it is important to consider how the physical stimulus of acupuncture is initially transduced into cellular signals. Another key question in acupuncture research is how mechanical needle manipulation is transduced into biochemical signals. Recent studies suggest that needle insertion may activate mechanosensitive ion channels such as Piezo 1/2 on local fibroblasts and adipocytes, triggering the release of adenosine and extracellular vesicles. These signals may propagate systemically, modulating energy metabolism and inflammation[21]. This mechanotransductive process likely serves as the initiating event that triggers the subsequent depot-specific responses discussed below. First, acupuncture exerts a more pronounced effect on the inflammatory response within visceral adipocytes. VAT typically exists in a state of higher chronic inflammation, being rich in macrophages and expressing elevated levels of pro-inflammatory cytokines such as TNF-α[22]. Acupuncture has been confirmed to effectively inhibit NOD-like receptor family pyrin domain containing 3 (NLRP3) inflammasome activation and downregulate levels of TNF-α and IL-6[23]. The significant reduction of VAT in this patient may be associated with acupuncture’s more potent amelioration of the unique inflammatory microenvironment in VAT, which also contributes to improving the patient’s overall metabolic inflammatory state. Second, acupuncture may amplify the disparity in lipolysis rates between VAT and SAT. In adipose tissue, sympathetic nerves promote lipolysis by releasing NE, which acts on β3-AR on the adipocyte surface[18]. Compared to SAT, VAT contains a higher density of β3-ARs and exhibits greater receptor sensitivity[18], granting it a stronger basal responsiveness to this pathway. Research indicates that acupuncture can upregulate β3-AR to enhance NE signaling[19] and inhibit monoamine oxidase A to reduce NE clearance[20]. This reinforcing effect of acupuncture may lead to a further relative increase in the lipolysis rate of VAT compared to SAT, potentially serving as a key mechanism underlying the rapid decreases observed in the patient’s waist circumference and VFT. Furthermore, acupuncture may promote more efficient energy expenditure in VAT. VAT is characterized by greater vascularity, richer blood supply, and denser innervation compared to SAT[22]. Since acupuncture promotes white adipose tissue browning and restores its thermogenic function primarily through mechanisms involving vascular remodeling and sympathetic nerve regulation[21], its effect on promoting browning might be more pronounced in VAT, thereby increasing local energy consumption and facilitating visceral fat breakdown. Acupuncture may also mimic the molecular effects of caloric restriction by activating the AMPK pathway, a master regulator of cellular energy homeostasis. AMPK activation promotes fatty acid oxidation, mitochondrial biogenesis, and inhibits lipogenesis. In obese individuals, acupuncture-induced AMPK signaling could enhance energy expenditure and improve insulin sensitivity[24]. Although post-treatment biomarkers such as leptin or adiponectin were not measured in this case, future studies should incorporate these to validate the molecular basis of acupuncture-induced weight loss. Complementing this AMPK-mediated enhancement of energy metabolism, acupuncture may further promote the browning of white adipose tissue through a distinct but synergistic mechanism. Catecholamine release induced by acupuncture can upregulate uncoupling protein 1 (UCP1) expression in subcutaneous fat, leading to increased thermogenesis and energy expenditure[21]. This UCP1-mediated thermogenic mechanism may contribute to the reduction in fat thickness observed in this patient, independent of dietary changes, and together with AMPK activation, represents a coordinated molecular response that maximizes energy consumption across different adipose depots. Additionally, dietary modifications induced by acupuncture could contribute to the heightened sensitivity of VAT. Evidence suggests that acupuncture can modulate key hypothalamic nuclei such as the arcuate nucleus, suppressing orexigenic signals and enhancing anorexigenic signals to inhibit appetite[25]. Concurrently, other research has found that very low-calorie diets can induce a maximal short-term reduction rate in VAT within the first 1-12 weeks of weight loss initiation[26]. The treatment duration in this case was 8 weeks from initiation to final measurement. During this period, the patient reported reduced appetite and decreased food intake attributable to acupuncture’s appetite-suppressing mechanism. Therefore, acupuncture-induced dietary changes might also be a contributing factor to the greater reduction in VFT compared to subcutaneous fat. Obesity exerts significant effects on a wide range of metabolic diseases through multiple biological pathways[27]. The patient in this case is a middle-aged male. Studies indicate that due to hormonal differences, men are more prone to fat accumulation in the abdominal visceral region and generally have higher VAT content than women[28]. Given that VAT is a significant risk factor for metabolic diseases such as cardiovascular disease and diabetes[29], higher VAT content correlates with greater metabolic disease risk. This patient had a history of fatty liver disease. Calculated based on blood lipid tests and ultrasound data, his Chinese visceral adiposity index (CVAI) was as high as 239.4 before treatment, indicating a very high risk for developing metabolic diseases like cardiovascular disease and diabetes without timely intervention. After eight weeks of acupuncture treatment, significant reductions were observed in waist circumference, VFT, CVAI, and visceral fat volume. This suggests that the aforementioned local effect mechanisms were likely effectively activated in this patient, not only reducing abdominal fat but also directly lowering his metabolic disease risk. Beyond these depot-specific effects, acupuncture also modulates the systemic inflammatory milieu that characterizes obesity. Obesity is characterized by chronic low-grade inflammation driven by M1 macrophage infiltration in adipose tissue. Acupuncture has been shown to inhibit the TLR4/NF-κB pathway and promote macrophage polarization toward an anti-inflammatory M2 phenotype, thereby reducing adipose tissue inflammation and improving metabolic health[23]. This anti-inflammatory effect likely complements the lipolytic and thermogenic mechanisms discussed above, creating a more favorable metabolic environment for sustained weight loss. The integrated molecular mechanisms discussed above, including mechanotransduction, sympathetic activation, depot-specific lipolysis, AMPK-mediated energy metabolism, UCP1-dependent thermogenesis, and anti-inflammatory modulation are schematically summarized in Figure 2.

Figure 2 Hypothesized molecular mechanisms underlying acupuncture-induced regional fat reduction. NE: Norepinephrine; β3-AR: Beta-3 adrenergic receptor; cAMP: Cyclic adenosine monophosphate; PKA: Protein kinase A; HSL: Hormone-sensitive lipase; p-HSL: Phosphorylated hormone-sensitive lipase; UCP1: Uncoupling protein 1; CVAI: Chinese visceral adiposity index; VAT: Visceral adipose tissue; AMPK: AMP-activated protein kinase; TLR4: Toll-like receptor 4; NF-κB: Nuclear factor kappa-light-chain-enhancer of activated B cells; IL-6: Interleukin-6; TNF-α: Tumor necrosis factor alpha.

Acupuncture stimulates mechanosensitive ion channels (Piezo 1/2), leading to adenosine release and activation of sympathetic nerves. Norepinephrine binds to β3-AR on adipocytes, activating the cAMP-PKA-HSL axis to promote lipolysis, with preferential effects in visceral fat due to higher β3-AR density[18-20]. Acupuncture also activates the AMPK pathway, enhancing fatty acid oxidation and mitochondrial biogenesis[24]. UCP1 upregulation induces thermogenesis in beige adipocytes, contributing to subcutaneous fat reduction[21]. Anti-inflammatory effects are mediated via inhibition of the TLR4/NF-κB pathway and macrophage M2 polarization, reducing pro-inflammatory cytokines such as IL-6 and TNF-α[23]. Solid arrows indicate established pathways; dashed arrows indicate hypothesized connections.

This case implies that acupuncture can modulate fat distribution, a conclusion also mentioned in studies by other teams such as Zhao et al[30]. The characteristic and advantage of our study lie in reporting that acupuncture may preferentially reduce the more hazardous visceral fat, thereby directly intervening in a core risk factor for metabolic diseases, and providing early clinical evidence for this effect. In the future, acupuncture could be promoted and applied as an advanced non-pharmacological strategy for preventing and managing metabolism-related diseases such as diabetes and cardiovascular disease. Considering the potential heightened sensitivity of VAT to acupuncture and the typically higher baseline VAT levels in populations such as males and those with abdominal obesity, future clinical practice could design acupuncture protocols focusing on abdominal or metabolism-regulating specific acupoints for such high metabolic-risk individuals. Their generalizability, optimal treatment parameters (e.g., acupoint selection, treatment course), and long-term effects require further verification and optimization through larger-sample randomized controlled trials, combined with more precise fat distribution measurement techniques such as magnetic resonance imaging[31].

CONCLUSION

Furthermore, the synergy between acupuncture’s appetite-suppressing effect and dietary changes contributed to the rapid reduction of VAT. This insight suggests that future weight loss therapies should proactively integrate acupuncture with nutritional guidance to form a comprehensive “acupuncture regulation + behavioral intervention” model, which may yield synergistic effects. It is important to clarify the cellular basis of the observed fat reduction. The reduction in fat thickness observed in this case is most likely due to a decrease in adipocyte size (hypertrophy) rather than a change in cell number, given the short treatment duration. This is consistent with the rapid lipolytic response of adipose tissue to sympathetic stimulation and aligns with the molecular mechanisms discussed above, particularly the activation of the cAMP-PKA-HSL lipolytic pathway and UCP1-mediated thermogenesis. Currently, the mechanisms underlying acupuncture’s selective reduction of VAT are largely reasonable hypotheses based on existing theories and limited research. Future studies necessitate rigorously designed, large-sample clinical trials employing modern imaging and molecular biology techniques to directly compare dynamic changes in inflammatory status, innervation, and the expression of genes related to lipolysis and thermogenesis in different fat depots following acupuncture intervention. This will help clarify the specific pathways involved, individual variations, and the influence of factors like gender, thereby providing a solid foundation for precise treatment.

ACKNOWLEDGEMENTS

We thank the staff of Nanjing University of Chinese Medicine for technical support.