〔Abstract〕 Objective To study the effect of acupuncture and moxibustion combined with exercise prescription on obesity in the elderly. Methods Seventy-six elderly obese patients recruited from The Third Affiliated Hospital of Luohe Medical College from January 2022 to August 2022 were selected and divided into an observation group and a control group according to random number table method, with 38 patients in each group. The control group was treated with exercise prescription, and the observation group was treated with acupuncture combined with exercise prescription. Before and after the intervention, the body shape related indexes such as body mass, body mass index (BMI), waist-to-hipratio were observed in the two groups. Metabolic syndrome (MS) risk score of the two groups, the body composition indicators such as the content of water, protein, body fat, inorganic salt, skeletal muscle and fat-free body mass, body fat percentage were observed. The lipid indexes suan as low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), total cholesterol (TC) and triacylglycerol (TG) were observed in the two groups. The levels of endothelin-1 (ET-1), nitric oxide (NO), von Willebrand factor (vWF) and adverse reaction were observed in the two groups. Results After intervention, body mass, BMI, waist-to-hipratio and MS risk score of the two groups were all lower than those before intervention, and body mass, BMI, waist-to-hipratio and MS risk score of the observation group were lower than those of the control group, with statistical significance (P < 0.05). After intervention, water content, body fat content and body fat percentage of the two groups were decreased compared with before intervention, and protein content was increased compared with before intervention, with statistical significance (P < 0.05). The water content, body fat content and body fat percentage in the observation group were lower than those in the control group, and protein content was higher than that in the control group, with statistical significance (P < 0.05). After intervention, there was no significant difference in inorganic salt, skeletal muscle content and fat-free body mass of the two groups compared with before intervention (P > 0.05). After intervention, the levels of LDL-C, TC and TG in the two groups were lower than those before intervention, the level of HDL-C was increased compared to that before ntervention, and the levels of LDL-C, TC and TG in the observation group were lower than those in the control group, the level of HDL-C was higher than that in the control group, with statistical significance (P < 0.05). After intervention, the serum levels of ET-1 and vWF in both groups were lower than those before intervention, and the level of NO was higher than that before intervention. The serum levels of ET-1 and vWF in the observation group were lower than those in the control group, and the level of NO was higher than that in the control group, with statistical significance (P < 0.05). No obvious adverse reactions were observed in both groups during the intervention. Conclusion Acupuncture and moxibustion combined with exercise prescription can improve the body shape, body composition, lipid indicators and vascular endothelial factor levels in obese elderly people, reduce the risk of MS, safe and reliable.