INTRODUCTION:

Obesity means having too much body fat. The obesity and overweight are two different things. Overweight means weighing too much than the normal. The human weight is due to bones, muscles, fat, and/or body water. Both the conditions the increased weight is harmful for the health of the human.

Obesity occurs due to increased in the calorie intake and decreased calorie loss. Factors affecting the obesity include genetic overeating, makeup, eating high-fatty diet, and not being physically active. Obesity is associated with increased incidence of cardiac problems, stroke, diabetes, arthritis, and some cancers.¹

In the present review, we briefly discussed the etiological factors that are responsible for obesity. Furthermore, we describe the complications associated with obesity. Finally, we summarize the herbal medicines with their mechanism of action for curing obesity.

Definition:

“Obesity on the basis of WHO criteria, is defined as the individuals showing body mass index (BMI) ≥30Kg/m², is due to an imbalance in which energy intake increased over energy expenditure for prolonged period, ultimately resulting in excessive body fat accumulation to degree that adversely affects health.”²

Etiology:

Obesity is caused by following factors,

1. Diet:

Eating too much is the one of main reason for the obesity. The diet including lot of calorie food, alcohol, soft drinks, fruit juices, high fat, sugar are responsible for increasing the weight.³Diet rich in fats and carbohydrate than the protein usually causes obesity.⁴ The food source which can able to increase the body weight also includes processed food, fatty meat, Bread, sodas, sweetened drinks, foods containing hidden sugars like ketchup.⁵It is proved that possible contributing factor of childhood obesity are the consumption of snack foods include chips, baked goods, and candy or increased fast food consumption, consumption of sugary beverages. Also it is proved that sugary beverages increased BMI like soda.⁶

2. Decreased physical activity:

One more important factor for the obesity is lack of physical activity. In today’s life most of the persons are having sitting jobs where they completely lack the walking. Also as the peoples are having own bike, cars or they use public transports to travel it also reduces the physical activity. Further during relaxation at home many people watch TV, Mobiles, browse, and play games on computer which again reduces regular exercise activity. If the person lacks the physical activity and still takes the calories then the calories are stored in the form of fat.³ This sedentary life style is main contributing factor to increase the body weight.^5,6 It is found that physical activity stabilizes the release of insulin while less physical activity will lead to unbalanced insulin and weight gain.⁵Further eating out or watching TV while eating is related with increased fatty intake. Also parental feeding and junk food eating are also important factors for increasing weight in childrens. Furthermore most of the children’s are drop at school by their parents or they have the bike this decrease the walking.⁶

3. Genetic makeup:

It is found that the obesity is caused due to specific genes which may runs in families such as Prader-Willi syndrome.³The genes named fat-mass and obesity-associated gene (FTO) are liable for some cases of obesity. It is also found that FTO gene in playing role in binge eating and emotional eating.⁵

4. Disease condition:

In some cases the peoples with underlying diseases like Hypothyroidism or Cushing syndrome may also cause the obesity.³ Other contributing diseases which can increase weight gain in adults and the children include sleep apnea, Type 2 diabetes, asthma, glucose intolerance and insulin resistance, fatty liver cardiovascular disease, high cholesterol etc.

5. Sleeplessness:

Researchers also proved that decreased sleep can also promote the obesity.⁶ The researchers examined the 28000 children’s and 15000 adults from 1977 to 2012 which showed that deprivation of sleep can lead to obesity. It is said that due to imbalance in hormonal levels might be the reason for the weight gain. Due to the less sleep ghrelin hormone released which increases the appetite while another hormone leptin is decreased which decreases the appetite.⁵

6. Use of Medications:

It is also reported that certain medicines like corticosteroids, antidepressants, anti-diabetic drug tolbutamide or antiepileptic such as gabapentin, atypical antipsychotic such as olanzapine, resperidone or quetiapine may be responsible for the weight gain.³

Symptoms:

Body mass index (BMI) greater than or equal to 30 is the indicator of obesity. Body mass index (BMI) defined as weight in kilograms by your height in meters squared. BMI higher than 30 indicates the higher amount of fat tissue. The athletes have higher BMI but it doesn’t mean that they are obese.⁷

Table no. 1. Body mass index and weight relation⁷

Sr. No.	BMI	Indication
01	Less than 18.5	Underweight
02	18.5 to 24.9	Normal
03	25 to 29.9	Overweight
04	30 to 39.9	Obese
05	≥ 40.0	Morbid obesity

Complications:

Individuals with obesity are prone to one or more health problems which may be harmful for healthy life. These complications includes,

1. Cardiovascular diseases and Stroke:

Obesity is associated with increased cholesterol level in body which is important factor for the development of cardiovascular diseases like hypertension.^4,8 Obesity will also lead to the stroke.⁹

2. Osteoarthritis:

Peoples with the obesity are overweight which can lead to the wear and tear of the joints.⁴ The increased weight is will create stress on the weight bearing bones.⁹

3. Sleep apnea:

Sleep apnea is common among obese people. It is the condition in which breathing repeatedly stops and starts during sleep.⁹

4. Cancer:

Amongst the all causes of cancer obesity estimates around 20%.¹⁰Obesity may lead to various types of cancer which may include colorectal cancer ovarian cancer, multiple myeloma, non Hodgkins lymphoma esophageal adenocarcinoma, leukemiaetc. Researchers proved that obesity may cause the cancers of various systems and organs such as breast, endometrial cancer, colon, rectum, uterus, kidney, gall bladder, liver, stomach or pancreatic cancer etc.^8,10,

5. Type 2 diabetes mellitus:

It is found that impaired insulin release and insulin resistance are major factors for the development of type 2 diabetes.¹¹

6. Depression:

Obesity was found to increase the risk of depression. Researchers proved that obese persons had a 55% increased risk of developing depression over time. Obesity can be seen as an inflammatory state, also increased weight can activate inflammatory pathways and inflammation in turn associated with depression. It is also reported that obesity increases risk of developing diabetes mellitus and increased insulin resistance which possibly leads to alterations in brain and increase the possibility of depression. Furthermore it is found that obesity may increase body unhappiness and decrease self-esteem, which are considered important risk factors for depression.¹²

7. Infertility:

In women, early onset of obesity leads to irregular menstrual cycle, chronic oligo-anovulation and infertility in the adult age. Obesity also increases risk of miscarriages. This might be caused due to insulin excess and insulin resistance. In men, obesity is linked with low testosterone levels. The overweight men show reduced spermatogenesis associated with severe hypotestosteronemia which may lead to infertility. Further erectile dysfunction is also increases with increasing body mass index.¹³ Moreover it is found that increased adipose tissue in women aggravates polycystic ovarian syndrome (PCOS).¹⁴

Herbal Medicines:

The use of herbal medicines is increasing day by day for the healthy well being of humans. This is due to the decreased side effects of herbal drugs. Currently for obesity treatment herbal medicines use is increased in recent years. Recently, it is found that the number of herbal medicines in curing obesity increased in past few years. Researchers also proved the exact mechanism of action of these herbal medicines intreating the obesity. As mentioned previously, herbal medicine show beneficial effects to overcome obesity and has less adverse effects than other pharmacological medicines such as diethylpropion, sibutramine, orlistat, phentermine, fluoxetine or bupropion. Furthermore, it is also proved that the herbal drugs can also be useful as anti-inflammatory, antidiabetic, antihyperlipidemic, antiobesity, and antioxidant.

Table No 2: Herbal medicines used for obesity

Sr No.	Name of Plant	Mode of action	Solvent and Part used for Extract	Model Performed	Reference
01	Garlic Extract Fermented by Lactobacillus Plantarum BL2	Inhibit plasma triacylglyceride and total cholesterol, suppressed adipogenesis by downregulation in mRNA and protein expression of peroxisome Proliferator-activated receptor gamma (PPARγ), C/EBPα, and lipogenic proteins, including SREBP-1c, FAS, and SCD-1	Garlic Extract Fermented by Lactobacillus Plantarum BL2	High fat diet fed mice	15
02	Rubus coreanus Miquel	suppressed the elevated mRNA levels of PPARγ in the adipose tissue, downregulating Adipogenesis and Lipogenesis	5% ethanol extract and n-hexane, chloroform, ethyl acetate and n-Butanol fractions	3T3-L1 Adipocytes And High fat diet fed C57BL/6 mice	16
03	Eriobotrya Japonica and Nelumbo Nucifera	Decreased the expression of PPARγ, SREBP-1c, FAS, and ACC	water and 50% ethanol extract	High fat diet fed mice and 3T3-L1 adipocytes	17
04	Nelumbo nucifera L., Morus alba L., and Raphanus sativus	Adipogenesis and lipogenesis-related genes were suppressed, while fat oxidation-related genes increased	Ethanol extract	C57BL/6J Obese Mice and 3T3-L1 adipocytes	18
05	Nelumbo nucifera	Inhibition of lipid accumulation and decreased expression of PPARγ, glucose transporter 4 (GLUT4), and leptin	Seed Ethanolic extract	Human pre-adipocytes and High fat fed diet rat	19
06	Gnidia glauca	Reduced body weight, organ weights, organo-somatic indices, anthropometric indices, the total fat content, adiposity index, atherogenic index as well as various lipid profiles.	Dichlorometahne Leaf extract	High fat diet fed obese rat	20
07	Cynomorium songaricum	Activation of the AMPK signaling pathway	Ethanolic extract	High fat diet fed obese mice	21
08	Erigeron annuus L. and Orago officinalis L.	Inhibited the expressions levels of adipogenic genes such as PPARγ, C/EBPα, and SREBP-1c, stimulated the production of adiponectin	50% Ethanolic extract and water extract	High fat diet fed obese C57BL/6 J mice and 3 T3-L1 adipocytes	22
09	Theobroma cacao L.	Decreases insulin, and leptin levels, and pro-inflammatory factors. Increases serum HDL levels, activation (AMPK, PPAR-γ, PPAR-α, SIRT1, Plin1, and PGC-1α) and repression (TNF-α, SREBP-1c, Leptin and ACC)	--	High fat diet fed obese rat	23
10	Solenostemma argel	attenuated liver steatosis, improved lipid profile, modulated adipokines activities, increased β-oxidation gene expression, decreased expression of lipogenesis-related genes	Ethanolic extract and its fractions (methylene chloride and n-butanol. 200 and 400 mg kg^-1	High fat diet fed obese rat	24
11	Cuscuta reflexa	Inhibition of triacylglyceride and total cholesterol, LDL, VLDL and glucose and enhanced HDL	Ethanolic extract	High fat diet fed obese wistar rat	25
12	Betula utilis	Inhibition of triacylglyceride (TG) and total cholesterol (TC), LDL, VLDL and glucose	Ethanolic extract 100–400 mg/kg/day p.o	High fat diet fed obese wistar rat	26
13	Crinum asiaticum var. japonicum	Suppress adipocyte differentiation through downregulation of PPARγ, C/EBPα, C/EBP β, and aP2. Also suppress the expression levels of ACC, FAS, LPL and HMGCR gene. Inhibits TC and TG	80% Ethanolic extract	High fat diet fed obese monogenic mice and 3T3-L1 adipocyte cells	27
14	Cynara scolymus	Inhibits pancreatic lipase, α-amylase, α-glucosidase, bile secretion, blood glucose. Enhances lipolysis and lipid metabolism.	--	---	28
15	Memecylon umbellatum	Inhibition of triacylglyceride (TG), ameliorates insulin resistance	Methanolic extract	High fat diet fed obese mice	29
16	Citrus aurantium L. and Caenorhabditis elegans	Decreased triglyceride (TG)	85% Ethanolic extract and its fractions [Ethyl acetate, Petroleum ether, Chloroform]	High fat diet fed obese mice and 3T3-L1 cells	30
17	Hibiscus sabdariffa	Improved glucose tolerance, insulin sensitivity and normalized LDL/HDL cholesterol	Phenolic extracts	High fat diet fed obese mice	31
18	Zingiber officinale Roscoe	increasing thermogenesis, increasing lipolysis, suppression of lipogenesis, inhibition of intestinal fat absorption, and controlling appetite	--	--	32
19	Mangifera indica L.	reduced abdominal fat accumulation, upregulated PPAR-γ and lipoprotein lipase (LPL) and downregulated (fatty acid synthase) FAS expression	Aqueous extract	High fat diet fed obese rat	33
20	Terminalia paniculata	Expression of adipogenesis-related genes such as Leptin, FAS, PPARgamma, and SREBP-1c were down regulated	Ethanolic extract of bark	High fat diet fed obese rat	34
21	Morinda citrifolia	Inhibition of pancreatic and lipoprotein activity and also visceral fat deposition	Leaf extarct	High fat diet fed obese Sprague-Dawley rat	35
22	Ephedra sinica	Upregulated expression of adiponectin and PPAR-α, and downregulated the expression of TNF-α	Hydroalcoholic extract	High fat diet fed obese Male ICR mice	36
23	Cissus quadrangularis	Reduced LDL-cholesterol, tri- glyceride and total cholesterol, lower C-reactive protein and fasting blood glucose	--	Human	37,38
24	Parkinsonia aculeata	Enhancement of the insulin signaling pathway and increase in PPARγ/CuZn-SOD axis expression	Dose: 125 and 250mg/kg/day. Hydroethanolic extract partitioned with ethyl acetate	High fat diet fed mice	39, 40
25	Curcuma longa L	Reduced white adipose tissue weight, serum triglyceride (TG), and cholesterol. Also increased expression of adipose triglyceride lipase, hormone-sensitive lipase, adiponectin, and AMP-activated protein kinase	50% ethanolic extract	High fat diet fed rat	41
26	Salvia Plebeia	Suppress expressions of genes related to adipogenesis and lipogenesis activity	Ethanolic extract [Dose. 200 and 400 mg/ kg extract]	High fat diet fed Male C57BL/6J mice	42
27	Viola mandshurica	Activation of AMPK and suppress PPARγ expression	Ethanolic extract	High fat diet fed mice	43
28	Grifola frondosa	Activation of PPARδ	--	High fat diet fed mice	44
29	Jacaranda decurrens	Serum total cholesterol and triglyceride levels decreased	Hydroethanolic Leaf extract	Hypercaloric diet-induced obesity in rat	45
30	Orthosiphon stamineus	Decrease in TG, TC and LDL	Ethanol Leaf extract	High fat diet fed mice	46
31	Dendropanax Morbifera	Inhibited adipogenesis by reducing intracellular triglyceride levels and glucose uptake	Aqueous Leaf extarct	3T3-L1 cells	47
32	Mulberry Plant	Decreased triglyceride, liver lipid peroxidation levels	Leaf and Fruit extract	High fat diet fed mice	48
33	Polygala tenuifolia	reducing lipid formation and triglyceride content and by increasing lipase activity in adipocytes, Inhibited lipid accumulation by inducing expression of PPARα, and also altered gut microbiota, Inhibits TG	--	High fat diet fed mice and 3T3-L1 adipocytes	49
34	Dioscoreophyllum cumminsii	Decreases HDL, LDL, VLDL cholesterol, TC and TG Reduces levels of insulin, leptin, protein carbonyland tumour necrosis factor-α and interleukin- (IL-) 6 and IL- 8 and increased adiponectin	Aqueous Leaf extract	High fat diet fed rat	50
35	Atractylodes lancea	Inhibits the lipase enzyme	Ethanolic rhizome extract	High fat diet fed mice	51
36	Memecylon umbellatum	Decreases hyperglycemia, body weight, triglycerides and ameliorates insulin resistance	Methanolic extract	High fat diet fed mice	52
37	Lotus seeds	Decreased lipid contents in mature 3T3-L1 cells and Down regulation of lipogenesis genes (PPARγ, aP2, LPL, C/EBPα, FAS, SREBP-1c) and upregulation of lipolysis genes (adiponectin and PPARα)	n-butanol extract of lotus seeds	3T3-L1 preadipocytes and in high-fat diet (HFD)-fed mice	53
38	Rhynchosia beddomei	Inhibits total cholesterol, triglycerides	Methanol, Chloroform, alcoholic and aqueous extract Dose: 100, 200 and 400 mg/kg	Progesteron induced Obesity in Mice and Mono Sodium Glutamate Induced Obesity in rats	54
39	Ficus religiosa	Inhibits TC, TG, HDL, LDL, VLDL, glucose, AST, ALT	Ethanolic extract Dose: 100 and 200 mg/kg	High fat diet fed Male Wistar albino rats	55
40	Citrus maxima	Inhibits serum levels of TC, TG, LDL, VLDL, SGOT, SGPT	Ethanolic extract of leaves Dose: 200 and 400mg/kg	Cafeteria diet and olanzapine induced obesity in Wistar Albino rats	56
41	Moringa oleifera	Reduces the TG and body weight	95% Ethanolic extract of seed	High-fat diet (HFD) induced obesity in mice	57
42	Ochna obtusata	Reduced the levels of TC, LDL and elevated the levels of HDL	Methanolic extract Dose: 200 and 400mg/kg	High Fat Diet Induced Obesity in Rats	58
43	Lantana camara	Decreases serum cholesterol, TG, LDL, VLDL levels	Methanolic extract	High Fat Diet Induced Obesity in Rats	59
44	Echinochloa crusgalli	Decrease in body weights, adipose tissue weight, SGOT, SGPT, blood glucose, LDL-C, VLDL-C, total cholesterol, triglyceride levels, atherogenic index, and increase in HDL-C levels	Hydro-Alcoholic Extract	high fat diet induced obesity in albino rats	60

CONCLUSION:

The issue of obesity is increasing day by day. Various parameters play role in developing obesity. The diet management, lifestyle modification and the physical activity can be useful in reducing obesity. If parents, for their children’s impose healthier lifestyle such as exercise, avoiding Junk food etc. then obesity can be prevented in children’s. Furthermore for healthy being, oneself if do physical activity, avoid junk food, eat healthy food then he can get rid of obesity or prevalence of obesity can be minimized. There are various marketed formulations which can claim effective therapy and safe for curing obesity. Also various researchers showed that the herbal drugs and their supplements are effective in managing the obesity such as ephedra, bitter melon, zinger, ginseng etc. In the present review we have discussed some of the herbal drugs with their mechanism of action, which can act promising therapeutic drugs for curing the obesity. Here we suggest that further profound study by isolating and characterizing the active constituents from the reported antiobesity herbal drugs will be beneficial for the humans for prevention and treatment of obesity and to form a healthier society.

CONFLICT OF INTEREST:

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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Received on 17.01.2020 Modified on 03.03.2020

Research J. Pharm. and Tech. 2020; 13(10):4966-4972.

DOI: 10.5958/0974-360X.2020.00871.9