Exploring the underlying mechanisms of obesity and diabetes and the potential of Traditional Chinese Medicine: an overview of the literature.

The short version

This literature review asks two connected questions: what actually drives obesity and type 2 diabetes at a biological level, and whether Traditional Chinese Medicine has anything to offer in managing them. The two conditions are closely linked — the review notes that type 2 diabetes accounts for roughly 90% of all diabetes cases and is strongly tied to excess weight. There is a practical bind behind the question, too: several standard diabetes drugs, including insulin and sulfonylureas, make weight loss harder rather than easier. The authors searched PubMed, Scopus and Web of Science for work published between 2019 and 2023, covering molecular, cellular and clinical studies of how obesity, diabetes and TCM interact. It is important to be clear about what kind of review this is: a narrative overview rather than a systematic one. There is no count of included trials, no pooled statistics and no formal assessment of study quality, so it maps a field rather than measuring an effect. On mechanism, the review draws a useful distinction between visceral fat — stored around the liver, pancreas and kidneys, hormonally active, and the type that drives insulin resistance — and subcutaneous fat sitting under the skin. This is why apple-shaped fat distribution carries more metabolic risk than pear-shaped. The scale of the problem is stark: the World Health Organization counted 1.9 billion overweight adults in 2016, 650 million of them with obesity, and 38.2 million children under five overweight or obese in 2019. The TCM proposal is that acupuncture, herbal remedies and dietary therapy act on inflammation, oxidative stress, insulin resistance and the balance of gut bacteria. What this review does not provide is evidence of how well any of that works. No effect sizes, no confidence intervals, no trial results for any specific TCM intervention appear. The authors themselves conclude only that TCM may be promising and that well-designed studies are still needed to confirm both efficacy and safety. Read it as a map of plausible mechanisms and an argument for research, not as grounds for choosing a treatment.

Key findings

• Visceral fat — stored around the liver, pancreas and kidneys — is hormonally active and drives insulin resistance, which is why apple-shaped fat distribution carries more metabolic risk than pear-shaped.
• The review proposes that acupuncture, Chinese herbal medicine and dietary therapy may work on obesity and diabetes through four mechanisms: inflammation, oxidative stress, insulin resistance and gut microbiota imbalance.
• Type 2 diabetes accounts for roughly 90% of all diabetes cases, and the World Health Organization counted 650 million adults with obesity in 2016.
• This is a narrative review, not a systematic one: it reports no trial counts, no pooled statistics and no quality assessment, so it maps the field rather than measuring whether these treatments work.
• The authors conclude that well-designed studies are still needed to confirm both the efficacy and the safety of TCM interventions for these conditions.

Common questions