Objective To explore the effect of Shu-mu acupoint catgut embedding (ACE) on appetite in abdominal obesity (AO) patients. Methods This is a secondary analysis of a multicenter, double-blind, randomized controlled trial. Which was conducted in China between July 2018 and June 2022. Eighty AO participants who received Shu-mu ACE intervention were divided into moderate appetite (MA) and strong appetite (SA) subgroups, according to the appetite at baseline. While 79 AO participants who received NACE intervention were also divided into MA and SA subgroups. All participants were given a 12-week actual intervention period and a 4-week follow-up. Appetite was assessed at baseline and after 6, 12 and 16 weeks. Results 71 participants who received Shu-mu ACE and 74 participants who received NACE were included in the final analysis. After the Shu-mu ACE, at 16 weeks, the appetite of the SA subgroup decreased to the same level as the MA subgroup (p > 0.05). All 36 AO participants’ appetite had decreased in the SA subgroup. While in the MA subgroup, 22 AO participants had a decrease in appetite, 7 increased, 4 had no change, and 2 had appetite data missing. During the NACE intervention and follow-up, the appetite of the SA subgroup was always higher than the MA subgroup (p < 0.01). In the SA subgroup, 32 decreased, 4 increased, 5 had no change, and 2 appetite data missing. While in the MA subgroup, 14 decreased, 7 increased, and 10 had no change. Conclusions Catgut embedding at Shu-mu acupoint could regulate the appetite of AO to the normal level, rather than dramatically inhibit the appetite. Trial registration This study was registered in the Chinese Clinical Trial Registry (registration number: ChiCTR1800016947). 4 July 2018; https://www.chictr.org.cn/showproj.aspx?proj=28782

Background: Acupoint catgut embedding (ACE) has been proven to be effective and safe in the treatment of obesity, but few studies have been conducted involving its central mechanisms. Our previous study has demonstrated the effectiveness of Shu-Mu ACE in the treatment of abdominal obesity (AO). However, the neurological mechanism of Shu-Mu ACE for weight loss has not yet been elucidated. The mechanism of the combination of the Shu and Mu acupoints may be related to the central integrative effects of the brain. This paper aims to explore the potential neural mechanisms of Shu-Mu ACE in female patients with AO. Methods and Analysis: A total of 100 eligible female AO patients and 20 healthy female subjects will be recruited for this study. 100 AO patients will be randomly allocated to five groups: Shu-Mu ACE (Group A), Shu ACE (Group B), Mu ACE (Group C), sham ACE (Group D), and waiting-list (Group E). Treatment will be administrated once every two weeks for 12 weeks. The body mass index (BMI), waist circumference (WC), Visual Analog Scales (VAS) of appetite, Self-Rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS) will be utilized to evaluate the clinical efficacy. Outcomes will be assessed at baseline and at each time point of treatment. Multimodal MRI will be performed at baseline and after 12-week treatment and the results will be used to investigate the neural mechanisms of ACE for obesity. Neurological changes and clinical data will be analysed for correlation. Discussions: This study hypothesized that Shu-Mu ACE therapy has a synergistic effect and may treat AO by modulating the neuropathological alterations in the brain. Our findings will demonstrate the neurological mechanism of AO treated by "Shu-Mu" Acupoint Catgut Embedding and compatibility relation. Trial Registration: This trial is registered at the Chinese Clinical Trial Registration Center (No. ChiCTR2100048920).

BACKGROUND Obesity is an increasing worldwide problem. Previous studies suggested that acupoint catgut embedding (ACE) may be an effective obesity treatment. However, the evidence for the efficacy of ACE in abdominal obesity (AO) remains inadequate due to the paucity of high-quality studies. OBJECTIVE This study aims to investigate the difference in the effectiveness of catgut embedding at acupoints and catgut embedding at non-acupoints in AO patients. METHODS This is a multicenter, double-blind, 16-week randomized controlled trial (RCT). A total of 92 eligible AO participants will be randomly divided into two groups (1:1 allocation ratio). The ACE group will receive catgut embedding at acupoints and the control group will receive catgut embedding at non-acupoints. The intervention will be performed every two weeks for a total of 6 sessions. Follow-up will be performed every two weeks for a total of 2 visits. The primary outcome is waist circumference (WC). Secondary outcomes include body weight (BW), body mass index (BMI), hip circumference (HC), and visual analog scale (VAS) of appetite. RESULTS This trial protocol was approved by the Institutional Review Board in June 2018. The start of recruitment began in August 2019 and is expected to end in September 2023. Upon completion of the trial, we will evaluate the effect of catgut embedding in acupoints or non-acupoints on obesity indicators in patients with AO. For treatment outcomes, an intention-to-treat analysis will be performed. CONCLUSIONS Although studies have been conducted to demonstrate the effectiveness of ACE in the treatment of obesity. However, the evidence for the efficacy of ACE in AO remains insufficient due to the quality of the studies. This rigorous normative randomized controlled trial will verify the effect of catgut embedding in acupoints or non-acupoints for AO. The findings will provide credible evidence as to whether ACE is an effective and durable treatment for AO. CLINICALTRIAL Chinese Clinical Trial Registry: ChiCTR1800016947; http://www.chictr.org.cn/showproj.aspx?proj=28782

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