• Article highlight
  • Article tables
  • Article images

Article History

Received : 18-03-2021

Accepted : 01-04-2021

Available online : 08-05-2021

Article Metrics

Downlaod Files


Article Access statistics

Viewed: 106

PDF Downloaded: 97

Dubey, Singh, Kumari, Patel, and Kumari: Obesity, its affecting factors and dietary approaches


Severe obesity is often associated with the prevalence of binge eating disorder, never relaxing or slackening, incessant hunger without sensations of satiety which leads to chronic eating disorders.1 Obesity is usually defined by the estimation of the body mass index (BMI). The BMI is calculated as weight/height, the weight is in kilograms and the height in meters. While the BMI does correlate with body fat as the weight can be of different aspect in form of body water, bone weight or visceral fat, in obese, a normal BMI may conceal underlying excess accumulation of fat. It can also be estimated by assessing waist-hip circumstances, skin fold thickness in the triceps, biceps, sub scapular and supra-iliac areas. A Dual-energy X-ray absorptiometry can also be used to assess total body composition and fat mass.2 Body mass index (BMI is a standard screening tool for obesity that is calculated by using weight in kilograms divided by the square of height in meters.3, 4 According to BMI range of obesity are in different categories as less than 18.5 kg/m2,18.5 kg/m2 to 24.9 kg/m2 and 25 kg/m2 to 29.9 kg/m2 BMI range are comes within Underweight, Normal range, Overweight, and Obese rangeare respectively. While obese subjects are further divided in three more categories, i.e.,

  1. 30 kg/m2 to 34.9 kg/m2as Class I obese,

  2. 35 kg/m2 to 39.9 kg/m2 as Class II obese,

  3. and more than 40 kg/m2 are consider Class III Obese,

Ideally, between 0.8 or less and 0.95 or lesser the waist-to-hip ratio should be considered significant in women and men respectively.5 Further evaluation studies like skin fold thickness, bioelectric impedance analysis, CT (computerized tomography), MRI (Magnetic resonance imaging), DEXA (dual-energy X-ray absorptiometry), water displacement, and air densitometry studies have been used as evidence for researchers.6 7 Associated medical complications from obesity can be evaluated by different laboratory studies include complete blood picture, the basic metabolic panel as an electrolyte and fluid balance, renal function, liver function study, lipid profile, HbA1C, TSH, vitamin D levels, urinalysis, CRP, other way like ECG, etc. 8

Obesity; a player for health complications

If one consumes excess amounts of energy, particularly from fat and sugars rather than from protein sources and lesser expenditure of the energy either through exercise or physical activity, much of the surplus energy will be stored by the body as fat which will enhance the rate of accumulation of visceral fat.9 In these conditions, losing weight is very difficult, along with this, the development of metabolic syndrome is induced 10. Metabolic syndrome is a cluster of metabolic abnormalities including at least three of the following disorders, abdominalobesity, hypertension, hyperglycemia, high serum triglyceride, and low serum high-density lipoprotein (HDL), elevated fasting plasma glucose, dyslipidemia, and an enhanced inflammation.11 Due to these circumstances, the probability of developing the risk of diabetes mellitus and cardiovascular disease is prominent. Medical conditions, such as a prothrombotic and proinflammatory state, fatty liver disease and obstructive sleep apnea syndrome were consecutively defined as symptoms of the metabolic abnormalities (12 13) . Central obesity and metabolic syndrome are accompanied by a declined quality of life and accelerate morbidity and mortality rates.

Obesity and its affecting factors

Many factors can affect weight and lead to overweight or obesity. Some of these factors may make it difficult to lose weight or to get away from regaining weight that have lost. By the analysis of different studies, it is prominent to evidence that when an obese subject with metabolic syndrome, having different choices of remedies including bariatric surgery14 , medication for weight loose, concomitant medication for the comorbidities accompanied with metabolic syndrome as diabetes, hyperlipidemia, and hypertension, or diet therapy, other medication and bariatric surgery have its certain side effect and risk therefore different dietary approach and nutrient interplay with timing that enhance the reduction of weight 15 and for the prolong maintain the enfeebled metabolic pathogenesis, should be at first sight treatment 16.

Family History and Genetic involved in obesity

As it tends to run in families, suggesting that genes may play a role.17 If one or both parents are overweight or have obesity, the chances of being overweight are greater. The Association of genetics and obesity is already well established by multiple studies. This gene might harbor multiple variants that increase the risk of obesity.18

Race or Ethnicity

Though obesity is most prevalent among non-Hispanic Blacks (African-Americans), individuals who lived in communities with a high concentration of non-Hispanic Blacks were no more likely to be obese than those living in other communities, regardless of their race/ethnicity. Many racial and ethnic minority groups are prone to obese. Studies show the importance of interacting individual-level strains with community-level racial/ethnic composition when one examines BMI and obesity. 19 In a study of Indian data, the North Indian (Delhi) subjects were found to be more obese, with the highest general obesity and relatively poor lung functions, which can be attributed to the lifestyle of the metropolitan city, categorized by a relatively faster life, irregular food habits, higher consumption of fast food, and lower physical activity. It was found that according to BMI categories, most subjects from Kerala were underweight. Subjects in Manipur were categorized by higher central adiposity despite having lesser general obesity levels and best respiratory efficiency.20

Age and Sex

Many people gain weight as growing. Children who have obesity are more likely to be obese as adults. Besides, adults who are having a normal BMI often start to gain weight in young adulthood and continue to gain weight until age 60 to 65. 21 Women are prone to build up fat in hips and buttocks while men usually build up fat in their abdomen or belly. Particularly if extra fats are around the abdomen, may put people at risk of many health problems even if they have a normal weight. Thus, sex may also affect where the body stores fat.22 Women are generally more prone to make conscious efforts to have a healthy diet ‘most of the time’, while men are 3 times more likely to ‘hardly ever’ make such efforts to take a healthy diet. (23 24 25

Eating behavior and physical activity habits

May raise your chances of becoming overweight and having obese if, eat and drink a lot of foods and beverages that are high in calories, sugar, and fat, drink a lot of beverages that are high in added sugars and spend a lot of time sitting or lying down and have limited physical activity,26 the significance of physical activity on public health and obesity as it identified as the fourth leading risk factor for global mortality27. The need for the development of global recommendations that show the links between the frequency, duration, intensity, type and the total amount of physical activity needed for the prevention of obesity and other non-communicable diseases. Greater than 60 minutes of physical activity for adolescence and 40 to 45 minutes for early adults while for adults daily physical activities will provide additional health benefits.28

Place to live, work, play, and worship

These factors may affect eating and physical activity habits, and access to healthy foods and places to be active. For example, living in an area that has a high number of grocery stores can increase access to better quality, lower-calorie foods. Living in a neighborhood with a lot of green spaces and areas for safe physical activity may encourage one to be more physically active. Area of work and worship may also make it easier for you to eat unhealthy, high-calorie foods. Vending machines, cafeterias, or special events at the workplace or place of worship may not offer healthy, lower-calorie options.29

Not enough sleep

People may eat more calories and snacks who don’t get enough sleep.30 Experts recommend that adults ages 18 to 64 get 7 to 9 hours of sleep a day and that adults ages above 65 or old age should get 7 to 8 hours of sleep a day.

Other factors, that can lead to weight gain include certain medical conditions, certain medicines,4 binge eating disorders,31 stress.32

Dietary approaches and Obesity prevention

The target of different Investigations that prolonged the successful maintenance of weight loss such as the National Weight Control Registry33 has recommended the dietary approach. Recent review-based studies show that the dietary approach related to the development of the metabolic syndrome presupposes the risk of diabetes and cardiovascular disease, and also has been reported a continuous reduction in risk of the metabolic syndrome arising by having a diet, rich in whole grains, legumes, nuts, high residue diet whereas the risk is being increased by a diet rich in white rice, refined flour, dehusked legume, low residue diet, preservative intake and salty or sweet snacks34. A Dietary Approaches to Stop Hypertension (DASH) 35 is a diet that promotes the intake of high fiber and high potassium and encourages a low sodium diet with low fat and low refined and preservative diet including vegetables, fruits, and low-fat dairy foods with moderate amounts of whole grains, fish, poultry, and nuts in the diet with foods rich in both micro and macronutrients that help lower blood pressure, such as potassium, calcium and magnesium has been shown in the different people to be associated with improved hypertension, high fasting glucose, and central obesity36.

Timing interplay of Diets

An appropriate number, duration and regularity of meals may affect obesity 37. Missing breakfast has been associated with an increased adverse metabolic risk and there is evidence to suggest that consumption of a high-quality breakfast with low energy density is associated with several improved markers of cardio metabolic health (serum uric acid, cholesterol, and measures on insulin resistance) in a cohort of 8–12-year-olds who were overweight or obese (7). Obesity is not only necessarily related to metabolic outcomes and major chronic comorbidities, but also it can be considered a seriously debilitating condition by itself.38 Much more of body fat may be accompanied by structural as well as functional abnormalities that reduced the quality of life, as gastrointestinal re flux disease, gallbladder disease, osteoarthritis, obstructive sleep apnea/obesity hypo ventilation consequences, psychological and eating behavior disorders, stress, anxiety and depression, and physical performance. 39 40 . Obesity requires multiprong and lifelong treatment strategies. A minimum weight loss of only 5%-10% can optimistically improve the quality of life, health, and economic burden of an individual as well as a country or a whole. Obesity has enormous healthcare costs exceeding $700 billion each year. To consume at least four meals daily is a well-defined good dietary strategy to reduce the prevalence of obesity or central obesity, with a breakfast containing less than 25 % of total daily calorie consumption; including a mid-morning and a mid-afternoon snack in the diet plan (that provide at least 15 % of total daily calorie intake) and should have lunch at an appropriate time (between 1-2 pm) with energy which contributes not more than 35 % of total daily calorie intake including the maximum number of foods belonging to the groups of dairy products, cereals and whole grains. (22)


Obesity is the world-wide new global threatening epidemic; millions of people have serious complications with associated diseases. Mainly due to the western food style and the junk food, meals high in carbohydrates & fats together with high-caloric sweets, etc. in developed countries. While in developing countries, obesity is found due to the main dependence on cheap foods which are characterized by low-protein and high- calorie content. Hence, it shows how important it is to combat obesity being with its many serious complications with many chronic diseases. A healthier lifestyle with better diet control should be encouraged to follow by the suffering people. obesity is a lifestyle disease and it should be early detected and treated, signs and symptoms of any transformation in lifestyle that leads to complications. Thus, the study concludes by establishing the association of meal frequency, nutrients interplay with time and amount and four meal patterns in obesity to identify a dietary strategy to mitigate the increasing prevalence of obesity.

Source of Funding


Conflict of Interest




C M Wurst M Ruggieri K C Allison Disordered eating and obesity: associations between binge eating-disorder, night-eating syndrome, and weight-related co-morbiditiesAnn N Y Acad Sci.20171411196105https://pubmed.ncbi.nlm.nih.gov/29044551/


O R Lopez J I R Boj F I Milagro M Cuervo L Goni J A Martinez Interplay of an Obesity-Based Genetic Risk Score with Dietary and Endocrine Factors on Insulin ResistanceNutrients201912133https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7019905/


A Z Ghosh A Jan Physiology, Body Mass IndexStatPearls Publishing2020https://www.ncbi.nlm.nih.gov/books/NBK535456/


A A Verhaegen L F V Gaal Drugs That Affect Body Weight, Body Fat Distribution, and MetabolismMDText. com, Inc2019https://www.ncbi.nlm.nih.gov/books/NBK537590/


A Dornelles Impact of multiple food environments on body mass indexPLoS One2019148219365https://pubmed.ncbi.nlm.nih.gov/31390365/


M Butovskaya A Sorokowska M Karwowski A Sabiniewicz J Fedenok D Dronova Waist-to-hip ratio, body-mass index, age and number of children in seven traditional societiesWaist-to-hip ratio, body-mass index, age and number of children in seven traditional societies. Scientific reports2009719https://www.nature.com/articles/s41598-017-01916-9


DLDuren R J Sherwood S A Czerwinski M Lee A C Choh R M Siervogel Body Composition Methods: Comparisons and InterpretationJ Diabetes Sci Technol200826113946https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769821/


L Arenaza V M Hernández M Medrano M Oses M Amasene E M Ramírez z Association of Breakfast Quality and Energy Density with Cardiometabolic Risk Factors in Overweight/Obese Children: Role of Physical ActivityNutrients20181081066https://pubmed.ncbi.nlm.nih.gov/30103429/


W H M Saris Sugars, energy metabolism, and body weight controlAm J Clin Nutr2003784850S57https://pubmed.ncbi.nlm.nih.gov/14522749/


S Sofer A H Stark Z Madar Nutrition Targeting by Food Timing: Time-Related Dietary Approaches to Combat Obesity and Metabolic SyndromeAdv Nutr 20156221423https://pubmed.ncbi.nlm.nih.gov/25770260/


Y Rochlani N V Pothineni S Kovelamudi J L Mehta Metabolic syndrome: pathophysiology, management, and modulation by natural compoundsTher Adv Cardiovasc Dis201711821525https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5933580/


M Lechleitner Obesity and the Metabolic Syndrome in the Elderly – A Mini-ReviewGerontol200854525359https://pubmed.ncbi.nlm.nih.gov/18841025/


S M Grundy Metabolic Syndrome PandemicArterioscler Thromb Vasc Biol 200828462936https://pubmed.ncbi.nlm.nih.gov/18174459/


B M Wolfe E Kvach R H Eckel Treatment of Obesity: Weight Loss and Bariatric SurgeryCirc Res 201611855184455https://pubmed.ncbi.nlm.nih.gov/27230645/


G Asher P S Corsi Time for Food: The Intimate Interplay between Nutrition, Metabolism, and the Circadian ClockCell201516118492https://pubmed.ncbi.nlm.nih.gov/25815987/


J M M Price P Petocz F Atkinson K O Neill S Samman K Steinbeck Comparison of 4 Diets of Varying Glycemic Load on Weight Loss and Cardiovascular Risk Reduction in Overweight and Obese Young AdultsArch Intern Med200616614146675https://pubmed.ncbi.nlm.nih.gov/16864756/


C Bouchard Childhood obesity: are genetic differences involved?Am J Clin Nutr200989514941501https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2677002/


B M Herrera C M Lindgren The Genetics of ObesityCurr Diab Rep2010106498505https://pubmed.ncbi.nlm.nih.gov/20931363/


J B Kirby L Liang H Jen Chen Y Wang Race, Place, and Obesity: The Complex Relationships Among Community Racial/Ethnic Composition, Individual Race/Ethnicity, and Obesity in the United StatesAm J Public Health20121028157278https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3464818/


S Kapoor N K Mungreiphy M Dhall R Tyagi K Saluja A Kumar Ethnicity, obesity and health pattern among Indian populationJ Nat Sci Biol Med201231529https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3361779/


A Hruby F B Hu The Epidemiology of Obesity: A Big PicturePharmacoEconomics201533767389https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4859313/


B F Palmer D J Clegg The sexual dimorphism of obesityMol Cell Endocrinol2015402113119https://pubmed.ncbi.nlm.nih.gov/25578600/


A Aparicio E R Rodríguez J A Bartrina Á Gil M G Gross L S Majem Differences in meal patterns and timing with regard to central obesity in the ANIBES (‘Anthropometric data, macronutrients and micronutrients intake, practice of physical activity, socioeconomic data and lifestyles in Spain’) StudyPublic Health Nutr20172013236473https://pubmed.ncbi.nlm.nih.gov/28413997/


J M Kearney M J Gibney B E Livingstone P J Robson M Kiely K Harrington Attitudes towards and beliefs about nutrition and health among a random sample of adults in the Republic of Ireland and Northern IrelandPublic Health Nutr200145a111726https://pubmed.ncbi.nlm.nih.gov/11820925/


Á P Hearty S N McCarthy J M Kearney M J Gibney Relationship between attitudes towards healthy eating and dietary behaviour, lifestyle and demographic factors in a representative sample of Irish adultsAppetite2007481111https://pubmed.ncbi.nlm.nih.gov/17049407/


A D Smethers B J Rolls Dietary management of obesity: cornerstones of healthy eating patternsMed Clin North Am2018102110724https://pubmed.ncbi.nlm.nih.gov/29156179/


Global health risks : mortality and burden of disease attributable to selected major risksWHO Technical Report Series2009https://apps.who.int/iris/handle/10665/44203


Global health risks: mortality and burden of disease attributable to selected major risks. Geneva, World Health Organization2009https://www.who.int/emergencies/diseases/novel-coronavirus-2019?gclid=CjwKCAjwg4-EBhBwEiwAzYAlsj0wtDdQs8je2dSgc2KyEslVOpOY-8c7g-auX9DQTq2hHzmti4VMoxoCae8QAvD_BwE


J F SALLIS K GLANZ Physical Activity and Food Environments: Solutions to the Obesity EpidemicMilbank Q200987112354https://pubmed.ncbi.nlm.nih.gov/19298418/


S M Greer A N Goldstein M P Walker The impact of sleep deprivation on food desire in the human brainNature Commun20134117https://www.nature.com/articles/ncomms3259


A Iqbal A Rehman Binge Eating DisorderEur PMC plus2019https://europepmc.org/article/NBK/nbk551700


K A Scott S J Melhorn R R Sakai Effects of Chronic Social Stress on ObesityCurr Obes Rep2012111625https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3428710/


S Calugi M Miniati C Milanese M Sartirana M Ghoch R D Grave Long-term weight loss maintenance for obesity: a multidisciplinary approachDiabetes Metab Syndr Obes201693746https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4777230/


F H Esfahani S Hosseinipour G Asghari Z Bahadoran N Moslehi M Golzarand Nutrition and Cardio-Metabolic Risk Factors: 20 Years of the Tehran Lipid and Glucose Study FindingsInt J Endocrinol Metab2018164e84772.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6289298/


H J Halla M A Ameer K R Uppaluri DASH Diet To Stop HypertensionStatPearls Publishing Copyright2020https://pubmed.ncbi.nlm.nih.gov/29494120/


S G Hamedani N Mohammadifard A Khosravi A Feizi S M Safavi Dietary approaches to stop hypertension diet and obesity: A cross-sectional study of Iranian children and adolescentsDietary approaches to stop hypertension diet and obesity: A cross-sectional study of Iranian children and adolescents. ARYA atherosclerosis2017131713https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5515185/


A Paoli G Tinsley A Bianco T Moro The Influence of Meal Frequency and Timing on Health in Humans: The Role of FastingNutrients2019114719https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6520689/


A D Lorenzo S Gratteri P Gualtieri A Cammarano P Bertucci L D Renzo Why primary obesity is a disease?J Transl Med201713https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-019-1919-y


A D Lorenzo S Gratteri P Gualtieri A Cammarano P Bertucci L D Renzo Why primary obesity is a disease?J Transl Med2019171169https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-019-1919-y


A M Jastreboff C M Kotz S Kahan A S Kelly S B Heymsfield Obesity as a Disease: The Obesity Society 2018 Position StatementObes (Silver Spring) 201927179https://pubmed.ncbi.nlm.nih.gov/30569641/


© This is an open access article distributed under the terms of the Creative Commons Attribution License - Attribution 4.0 International (CC BY 4.0). which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.