Objectives: The purpose of this study was to determine whether gocho (苦椒) extract mesotherapy can effectively reduce weight and abdominal fat in obese patients. Methods: Forty obese participants were recruited and randomly assigned to two groups. Five participants dropped out voluntarily during the course of the study and four men were excluded from the analysis to avoid gender bias. Results are presented on a total of thirty-one women. Over an eight-week period, the treatment group (n=13) received gocho (苦椒) extract injections (100mcg/3cc) in the abdominal skin, twice per week; the control group (n=18) received normal saline injections (3cc). A mixed lidocaine and prilocaine cream (2.5%/2.5% EMLA cream) was applied before the injection. At baseline and 8 weeks, body weight, body-mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), abdominal fat, energy expenditure, and questionnaires (eating attitudes and physical activity) were evaluated in both groups. Results: Reductions in body weight (p<0.005), BMI, and WC (p<0.05) were greater in the treatment group. WHR, total fat area, and visceral fat area decreased only in the treatment group (p<0.05). Resting metabolic rate (RMR) change was correlated with weight loss only in the control group (r=-0.498, p<0.05). Before and after the treatment, there were no significant differences between the two groups in questionnaire variables (p>0.05). Conclusion: his study suggests that abdominal gocho (苦椒) extract mesotherapy might be an effective way to promote weight and abdominal fat loss in obese Korean women.