Background: Obesity has become a global public health concern. Manual acupuncture may facilitate weight reduction. This study aims to investigate the differential effects of various manual acupuncture interventions on obesity treatment in a rat model. Methods: Rats were randomly divided into five groups: control, model, conventional acupuncture, high-frequency twisting, and low-frequency twisting. Except for the control group, all other groups were fed a high-fat diet for 8 weeks. The conventional acupuncture group received conventional acupuncture treatment, while the high-frequency and low-frequency twisting groups received conventional acupuncture combined with high-frequency and low-frequency twisting interventions, respectively. All treatments lasted for 4 weeks. Results: Acupuncture treatment contributes to body weight reduction. The Lee index was significantly lower in the acupuncture treatment groups. Acupuncture treatment improved the dysregulated lipid profiles in rat serum. Furthermore, enzyme-linked immunosorbent assay (ELISA) demonstrated that acupuncture treatment downregulated the levels of pro-inflammatory cytokines in the liver. Liver morphological alterations and the presence of lipid droplets were alleviated by acupuncture treatment. The two additional acupuncture groups exhibited better therapeutic effects compared with the conventional acupuncture group, with the high-frequency twisting group showing the most pronounced improvement. Additionally, variations in the SIRT1/SREBP-1c/PPARγ signaling pathway may account for the differential effects of acupuncture on obesity. Conclusion: Acupuncture treatment inhibited the development of obesity. Among the acupuncture treatment groups, the high-frequency twisting group achieved the most significant improvements in body weight and other related parameters. Overall, this study suggested the combination of conventional acupuncture with high-frequency twisting is the most appropriate intervention for the treatment of obesity.
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