Abstract
Objective
An increasing prevalence of overweight and obesity across the world can lead to serious health complications. The present narrative review highlighted the results of research on obesity management affiliated to the Endocrinology and Metabolism Research Institute (EMRI), Tehran University of Medical Sciences.
Methods
All documents from the EMRI focused on obesity topics were searched using PubMed and Scopus databases up to December 2019.
Results
EMRI research projects conducted in obesity field cover several topics including childhood obesity, epidemiology of obesity, roles of genetic factors and gut microbiota in excess weight, as well as weight management by medicinal herbs and nutritional interventions. The increasing prevalence of excess-weight in children and adults indicates that conventional weight management strategies alone are not successful in obesity control and complementary therapies including herbal medicine could be helpful. Moreover, clarifying the role of the human genome and microbiome in different responses of individuals to dietary recommendations could be effective in achieving personalized nutrition.
Conclusion
Further population-based studies focusing on national and international collaborations are needed to progress more practical strategies to face with obesity challenge in different age ranges.
Keywords: Obesity, Overweight, Metabolic syndrome, Microbiota, Herbal medicine
Introduction
More than 1.7 billion adults have excess weight among them 312 million are obese worldwide. Obesity is one of the main public health challenges and the fifth cause of mortality globally; Over 2.6 million people annually die due to obesity and its related complications [1–3]. Apart from economic, social and psychological consequences of obesity, overweight people are at increased risk for all-causes mortality and many health conditions like hypertension, dyslipidemia, type 2 diabetes, coronary heart disease, osteoarthritis, mental disorders and many types of cancer [1, 2].
Obesity has multi-factorial nature and various environmental, genetic, neural hormonal functions and infectious factors could play role in excess weight [2]. Recognition of obesity predictors in different age groups and providing a deeper insight into this problem help the development of interventional strategies for weight management. Indeed, it is very difficult for people to continue the diet and maintain the lost weight; as a result, there is a need for adjunctive solutions such as new drugs or supplements beside simplistic behavioral strategies for weight control including increasing physical activity and altering eating habits. Moreover, more studies are needed to achieve the goal of personalized nutrition.
In the present study, we aimed to review all the findings of publications by Obesity and Eating Habits Research Center of Tehran University of Medical Sciences concerning overweight and obesity.
Methods
All articles regarding the overweight and obesity affiliated to Obesity and Eating Habits Research Center of Tehran University of Medical Sciences were searched using PubMed and Scopus databases, with no restriction regarding publication date up to December 2019. The terms including “Body mass index” OR “Obesity” OR “Obese” OR “Overweight” OR “Waist circumference” in Title/Abstract AND “Obesity and Eating Habits Research Center” as affiliation were searched. Apart from relevant English papers, gray literatures and articles with Persian language have been also considered.
Results and discussion
Assessment of obesity and its related complications in pediatrics
Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable Disease (CASPIAN) study is a national school-based surveillance program which was performed among 7–18 years students selected by multistage random cluster sampling. This survey was implemented in urban and rural areas of 30 provinces of Iran in five phases from 2003 onwards [4].
According to data obtained from the fifth phase of CASPIAN study, among 14,440 students, the rates of underweight, normal weight and excess weight in all participants were 20.9%, 63.1% and 16%, respectively. The prevalence of low physical activity and high screen time was reported 58.2% and 17.7%, respectively. It was shown that parental obesity was associated with increased risk of cardio-metabolic disorders, high screen-based activities and low physical activity in children [5],[6]. The cut-off values of some predictive indices for obesity and metabolic syndrome in children and adolescents including Triglycerides-Glucose (TYG) index and non-high-density lipoprotein cholesterol (non-HDL-C) index were evaluated in these studies. The cutoff value of the TYG index as an appropriate substitute marker of insulin resistance, was estimated 8.33 [7], while this value for serum non-HDL-C was determined 120 mg/dl for predicting MetS in children and adolescents. Moreover, findings show that non-HDL-C is suitable for both risk classification and long-term control of cardiovascular events in the clinical assessments [8].
The optimal waist circumference-to‐height ratio (WHtR) cutoff value as a screening tool for general obesity in children and adolescents, was estimated 0.49 and 0.48 for boys and girls, respectively; this value was 0.50 for central obesity according to WC ≥ 90th percentile for both genders [9]. Validity of the continuous metabolic syndrome (cMetS) score as a highly accurate index in predicting pediatrics with MetS was assessed in all gender and age groups and 1.76 was determined as the optimal cutoff point in both genders [10]. Moreover, it was reported that higher anthropometric indices were associated with higher cMetS risk score in children and adolescents [11].
Evaluating the effect of dietary quality and food choices on anthropometric measures and blood pressure (BP) showed that the frequency of fresh fruits and vegetables consumption was not associated with obesity and BP. However, the consumption of dried fruits was associated with general obesity [12]. Moreover, junk foods consumption increased the risk of both general and abdominal obesity in children [13].
Investigating the role of adolescents’ weight status in life satisfaction showed significant associations between life satisfaction and perception of weight, peer, family and school in both genders [14]. It should be noted that different weight control strategies including life style changes, dietary habits modification, and even pharmacologic therapies should be considered in pediatrics to prevent adulthood obesity and its consequent complications [15].
Epidemiological studies on obesity in adults
According to a systematic review, the prevalence of overweight and obesity in Iranian adults was 27.0-38.5 (95% CI: 26.8–27.1, 37.2–39.8) and 12.6–25.9 (95% CI: 12.2–13.0, 24.9–26.8), respectively. In pediatrics, the prevalence range of overweight and obesity was 5.0-13.5 (95% CI: 4.5–5.5, 13.4–13.6) and 3.2–11.9 (95% CI: 3.0-3.4, 11.3–12.4), respectively. This study revealed that although the reported prevalence of obesity in different cities of Iran was not considerably diverse, remarkable differences were highlighted in the sub national prevalence of obesity especially for women and children. This issue must be getting more attention in national decision making and political health programming [2]. The prevalence of obesity and MetS was also examined in some specific populations such as military personnel and veterans. The prevalence of overweight, obesity and MetS were 47.59%, 15.05% and 11.1%, respectively in male military personnel. Notably, it was higher than the prevalence in military personnel of other countries [16]. Furthermore, the prevalence of MetS in veterans with bilateral lower limb amputation was 62.1% which was significantly higher than general population [17].
Genetic concepts of obesity in Iranian population
A review conducted on the role of polymorphisms of interleukin-6 (IL-6) as a pro-inflammatory cytokine on obesity showed that minor alleles of rs1800795 raised and rs1800797 reduced the risk of obesity, while rs1800796 and rs2069845 were not associated [18]. Results of a cross-sectional study investigating the effect of adiponectin gene polymorphisms on waist circumference of patients with type 2 diabetes demonstrated that abdominal obesity in GA or AA carriers of adiponectin – 11,391 G/A genotype increased significantly and this relation was independent of age and sex [19]. Another study that assessed the association between WHtR and adiponectin gene polymorphisms in Iranian population showed that the frequency of GG genotype was significantly increased in subjects with WHtR > 0.5. Abdominal obesity was significantly associated with the − 11,391 G/A polymorphism after adjustment for diabetes [20]. A cross-sectional study evaluated the gender-specific differences in the association of adiponectin gene polymorphisms with BMI and showed a significantly higher BMI in women and GA or AA carriers of -11391G/A polymorphism. Furthermore, there was a significantly lower WC in females and GG carriers of + 45T/G [21]. Another study revealed that rp48Arg polymorphism of the CD11c gene was not associated with increased risk of obesity among Iranian population [22].
Application of medicinal herbs in obesity management
Several systematic reviews on safety and efficacy of medicinal herbs in obesity management in human models showed that a wide variety of medicinal herbs, including their extracts or active compounds isolated from plants, can be used for weight loss and prevention of weight gain [23]. Nigella Sativa, Camellia Synensis, Green Tea, and Black Chinese Tea showed satisfactory anti-obesity effects. The effect size of these medicinal plants is a critical point that should be considered for interpretation [24]. It was revealed that compounds containing ephedra, CQ, ginseng, bitter melon, and zingiber were effective in managing the obesity [25]. Supplementation with Nigella Sativa and Itrifal Saghir exerted a moderate effect on reduction of body weight, BMI and WC [26, 27]. Moreover, supplementation with resveratrol showed beneficial effects on reducing BMI and WC [28]. It has been shown that supplementation with curcumin can decrease body weight and BMI, while its effects on WC was not considerable. However, the effect of curcumin on WC was significant with dosage equal or more than 1000 mg/day in overweight subjects after ≥ 8 weeks of intervention [29]. Randomized controlled trials also showed that using medicinal herbs is an inexpensive appropriate strategy to treat metabolic disorders [30]. A clinical trial conducted in patients with MetS showed that treatment with 12 weeks of dill extract had a beneficial effect on serum levels of TG compared to the baseline [31].
Role of gut microbiota in obesity
In recent years, role of unbalanced gut microbiota in developing endocrine disorders has been revealed [32–34]. Obesity as one of the major metabolic disorders has been studied extensively in recent decade [34, 35]. Gut microbiota plays critical roles in weight management via regulating of immune functions, controlling appetite, lipid accumulation, and production of short chain fatty acids [32]. Gut microbiota-brain axis can be a novel target for developing anti-obesity medications [36]. However, potential of the gut microbiota besides to human genome for developing novel personalized therapeutics needs further investigations [37] (Fig. 1).
Fig. 1.
Future perspective of obesity management
Systematic reviews on the role of gut microbiota in obesity showed that weight loss after bariatric surgeries was associated with microbiota modifications caused by surgical procedures [38, 39]. Moreover, alteration of gut microbiota after consumption of herbal products showed beneficial effects on restoring healthy gut microbiome besides body fat reduction [40]. It seems that apart from probiotics that exert beneficial effects partly via modifying the gut microbiota composition [41–43], some medications such as metformin also work through this mechanism [44].
Weight control with nutritional interventions
Breakfast consumption pattern and its association with overweight and obesity was evaluated in a population-based study and it was shown that breakfast consumption was inversely associated with the risk of overweight and obesity in university students [45]. The effect of conjugated linoleic acid (CLA) on obesity was assessed in a systematic review and meta-analysis. It was shown that supplementation with CLA can slightly reduce body weight and fat mass as well as increase lean body mass in overweight and obese subjects. However, its efficacy was not clinically considerable [46].
Conclusions
The current review summarized key findings of the epidemiologic and clinical studies related to obesity field conducted at EMRI focusing on the prevalence of adulthood and childhood obesity, genetic and microbiota concepts in weight disorders, herbal interventions and nutritional management of obesity. Considering the high prevalence of general and abdominal obesity in Iran, further population-based studies are needed for a comprehensive understanding of the genetic and environmental determinants of obesity and its related comorbidities in Iranian population. Moreover, to obtain a bigger picture of the obesity problem at a national level and to reach preventive strategies, academic collaborations between research institutes in this field need to be expanded.
Authors’ contributions
HSE, SHR and BL designed the study and drafted the manuscript. ARS helped in data extraction and interpretation of data. All authors read and approved the final manuscript.
Data availability
Not applicable.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no competing interests.
Consent for publication
Not applicable.
Ethics approval and consent to participate
Not applicable.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Contributor Information
Shirin Hasani-Ranjbar, Email: shirinhasanir@yahoo.com.
Ahmad-Reza Soroush, Email: soroush1344@gmail.com.
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