<p>Adipose tissue serves as a key endocrine organ for dynamic lipid metabolism in the human body, in which adipocytes store and consume energy, secrete adipokines, and participate in diverse biological processes. Adipose-derived stem cells exhibit a robust capacity for adipogenic differentiation. The hypothalamus, a critical brain region within the central nervous system, regulates systemic lipid metabolism by modulating energy homeostasis, feeding behavior, immune responses, and gut microbiota equilibrium. Lipid droplets function as essential organelles within adipocytes. Collectively, adipose tissue and the hypothalamus maintain systemic lipid metabolic homeostasis. Acupuncture exerts beneficial regulatory effects on lipid metabolism by modulating the central regulatory functions of the hypothalamus, thereby influencing the neuro-endocrine-immune axis. In the process of acupuncture-mediated regulation of lipid metabolism, the autonomic nervous system serves as both an afferent and an efferent pathway, playing a pivotal role in signal transduction. This review synthesizes the current research on how acupuncture transmits stimulation signals to the central nervous system, modulates sympathetic and parasympathetic signaling, and subsequently affects the structure and function of adipose tissue to promote lipid metabolic homeostasis. However, fundamental and clinical investigations into the “neuro-endocrine-adipose tissue” axis underlying acupuncture-mediated lipid metabolism regulation require further elucidation. This article aims to systematically review the interconnected pathways through which acupuncture regulates lipid metabolism via the neuro-endocrine-adipose axis. It provides an in-depth exploration of how acupuncture stimulation, via peripheral and central neural pathways, modulates the hypothalamic–pituitary–target gland axis and the autonomic nervous system, ultimately influencing the function and interaction of white and brown adipose tissues, as well as the process of “white adipose browning.” By integrating recent research advances, this review seeks to clarify the scientific basis of acupuncture in treating lipid metabolism disorders and to propose theoretical frameworks and directions for future mechanistic studies.</p> Graphical Abstract <p></p>