This study was designed to compare the weight reduction effects of acupuncture for obese women with or without perimenopausal syndrome. We observed 60 women with either simple obesity or perimenopausal obesity (obesity complicated with perimenopausal syndrome) treated by five acupuncture treatments given in the first week of three successive four-week treatment courses, and obesity indexes including body weight, body mass index, obesity degree and waist/hip ratio were evaluated. Versus baseline, the obesity indexes decreased at the end of each treatment course in women with simple obesity (p < 0.05 or p < 0.01), while women with perimenopausal obesity showed no decrease at the end of the first course of treatment, and these indexes decreased at the end of the second and the third courses of treatment (p < 0.05). There was no difference when comparing obesity indexes recorded at the end of three courses of treatment and at the end of three-month follow-up between women with simple obesity and those with perimenopausal obesity. The results suggest that acupuncture reduced body weight in the obese women, and the weight loss occurred earlier in the treatment process for simple obesity than perimenopausal obesity.