Prevalence and Risk Factors of Obesity in Ethnic Indian Population

This narrative review focuses on the prevalence and risk factors of obesity in adults with age group 40-70 in ethnic Indian population. It also highlights the significance of the study, research gap of previous studies, research questions, aims and objectives, methodology, data collection and analysis, and results.

Running head: NARRATIVE REVIEW
NARRATIVE REVIEW
THE PREVALENCE AND RISK FACTORS OF OBESITY IN ADULTS WITH AGE GROUP
40-70 IN ETHNIC INDIAN POPULATION
Name of the student:
Name of the University:
Author note:

1NARRATIVE REVIEW
1. Introduction:
Obesity is considered as the health condition in which body accumulates excess fat in a
high rate that could affect the health condition of individual, thus could reduce the expectancy of
life and increase enormous health issues. In Western countries obesity is defined as a condition
when BMI is measured by dividing the weight of a person by the square of the height of the
person and the result exceeds 30 kg/m2. The BMI range from 25-30 kg/m2 is considered as
overweight (1). The paper will focus on the prevalence and risk factors of obesity in India as
obesity has reached the epidemic level in the country.
1.1 Background:
Like the other countries in the world obesity has become a threat for the health care
system in the ethnic Indian population (2). The major ethnic Indians include Indo-Aryan,
Dravidian and Mongoloid. There are 72% population in India that are Indo-Aryan, 25% are
Dravidian and 3% are Mongoloid. Indo Aryans are mainly located in the central north part of
India, Mongoloids are resided in the borders of India with Nepal and China and Dravidians are
located in the south part of India. Research has been found that obesity has reached to the
epidemic level in the ethnic Indian population in the 21st century and Indo-Aryan population is
more vulnerable to obesity (3). The rate of morbid obesity in the population is 5%. Unhealthy
and poorly processed food has become highly accessible in the country and India has integrated
continuously in the global food markets (4). Such situation has lead to the increase in the average
calorie intake in individual. According to the research obesity is one of the major causes of
severe disease such as cardiovascular risk and cancer (5). Thus, it has created pressure in the
health workforce. According to a study the rate of obesity has been increased in last 10 years. In

2NARRATIVE REVIEW
India 12.1% males and 16% females are suffering from obesity. Near about 3.4 million adults die
per year due to obesity (6).
1.2 Significance of the study:
Research has been introduced in order to recognize the factors that influence obesity.
Researchers have indicated various factors such as overeating, lack of physical activity, genetics,
lifestyle and many others. Based on the research interventions have been introduced to reduce
the rate of obesity in the population. However, instead of reduction, the obesity rate is increasing
gradually in the country (7). It has been found that lack of awareness regarding the harmful
effects of obesity plays a vital role in creating obstacle in the prevention of obesity in the
population. People are more addicted towards unhealthy food. Lack of information related to the
importance of healthy diet and proper nutrition also contributes to the increasing rate of obesity
in the population. Thus, the research is important because it is necessary to provide adequate
evidence to the population regarding the prevalence of obesity and its harmful effect on health in
order to create awareness in the country. In this regards the following paper will provide brief
information about the findings provided by the earlier research on obesity.
1.3 Research Gap of Previous Studies:
Previous research has provided effective information regarding the factors influencing
obesity and interventions to address them in ethnic Indian population. However, research has
failed to create awareness and provide adequate way to utilize the interventions in order to
address the issue of obesity in the ethnic Indian population. The study will focus to bridge the
gap in an effective manner to reduce the prevalence of obesity and increase well-being in the
ethnic Indian population.

3NARRATIVE REVIEW
1.4 Research Questions:
 Why the prevalence of obesity in adults with 40-70 years age in ethnic Indian population
is increasing?
 What are the factors that influence obesity in the ethnic Indian population?
 How can these factors be addressed to reduce the prevalence of obesity in ethnic Indian
population?
1.5 Research Aims:
 To find out the reason of increase in the prevalence of obesity in the ethnic Indian
population.
 To investigate the factors of obesity in order to introduce effective strategies to mitigate
the issue of obesity in the ethnic Indian population.
 To provide adequate information to determine how can these factors be addressed to
reduce the rate of obesity in ethnic Indian population.
1.6 Research Objectives:
 To find out relevant literature from databases and analyse them to identify the factors
influencing obesity and strategies to address them.
 To identify why the prevalence of obesity is increasing in adults with 40-70 years age in
ethnic Indian population.
 To establish clear theme.

4NARRATIVE REVIEW
2. Methodology:
Narrative literature review define as the description and discussion of subject, state of
science, theoretical approaches, contextual points and themes of relevant articles to summarise
the findings of the articles regarding the topic and increase knowledge. Such narrative review
would help to find out previous research materials regarding obesity and help to provide
adequate knowledge to the people in the country in order to create awareness regarding the
consequence of obesity. It would help to identify the gap of the previous studies so that further
study could conduct in order to address the gap (8).
2.1 Data collection:
In this study in order to address the research questions, electronic bases were searched for
studies which were conducted in relation to the prevalence of obesity focusing mainly the
prevalence of the disorder in India. Journals were also hand searched in order to retrieve
information from the journals. Use of appropriate key words that were required in order to carry
out the review of literature. There was no requirement of ethical approval required for
conducting the review since it was narrative in nature. The electronic database sources included
Pubmed and Google Scholar. In this way the narrative review would help to answer the research
questions and achieve expected outcomes.
2.2 Data Analysis:
The aim of the methodology consisted of reviewing the journals and compiling the
information that is retrieved from those journals. The collected data was further required to be
synthesizes. After this thematic analysis of the data will be carried out in order to identify the
various risk factors that are related with the prevalence of obesity mainly in India. Additionally

5NARRATIVE REVIEW
focus will be given on the factors associated with obesity in the individuals of the age group of
40-70 years. Easy language, relevant content and literature from current year that is not older
than 5 years would be the focus of the data analysis. A total of 52 articles were selected and out
of them 23 best evidences were reviewed in order to conduct the study. With the help of
narrative review, in a short period of time a wide overview of the research those have been
conducted can be identified.
3. Results:
Among the chosen journals, most of them focused on the factors and the risk factors
associated with obesity. Some of the papers highlighted the context of obesity in India. Whereas
few of them discussed the prevalence of the disease in the older adults especially of the given
age group.
It is expected that the papers that are reviewed would show the relation of obesity with
cardiovascular disease and discuss about the childhood overweight and obesity prevalent in
India. Several studies would show the link between the body mass index (BMI) with obesity
along with the occurrence of diabetes. The studies identified obesity to be a major cause of
various disease and disorders, one being diabetes. The papers also identified obesity as being
epidemic in certain situations as stated. It is expected that result would provide effective
interventions that have been taken to counter the issue of obesity in the population.

Running head: NARRATIVE REVIEW
3.1 List of the reviewed paper:
Name of database: Google scholar
Ethnic
Indian
population
Obesity Risk Factors Factors that influence
the risk factors
Interventions Hits First
screen:
Hits
(Abstrac
t)
Second
screen:
Quality:
Hits
Cohn BS.
Notes on the
History of
the Study of
Indian
Society and
Culture.
InStructure
and change
in Indian
1. Kalra S,
Unnikrishnan AG.
Obesity in India:
The weight of the
nation. Journal of
Medical Nutrition
and Nutraceuticals.
2012 Jan 1;1(1):37.
2. Youngson NA,
Morris MJ. What
Severe health
issues and
death as well.
Income, smoking,
diet, substance abuse,
genetics.
Socioeconomic
intervention, providing
knowledge, introduce
clinical interventions,
create awareness.
24 16 8

1NARRATIVE REVIEW
society 2017
Nov 13 (pp.
3-28).
Routledge
obesity research tells
us about epigenetic
mechanisms. Phil.
Trans. R. Soc. B.
2013 Jan
5;368(1609):201103
37.
3. Carvajal R, Wadden
TA, Tsai AG, Peck
K, Moran CH.
Managing obesity in
primary care
practice: a narrative
review. Annals of
the New York
Academy of
Sciences. 2013

2NARRATIVE REVIEW
Apr;1281(1):191-
206.
4. Wright J, Harwood
V, editors.
Biopolitics and
the'obesity
epidemic': governing
bodies. Routledge;
2012 Mar 22.
5. Wright J. Biopower,
biopedagogies and
the obesity
epidemic.
InBiopolitics and
the'Obesity
Epidemic' 2012 Mar
22 (pp. 9-22).

3NARRATIVE REVIEW
Routledge.
6. Abarca-Gómez L,
Abdeen ZA, Hamid
ZA, Abu-Rmeileh
NM, Acosta-Cazares
B, Acuin C, Adams
RJ, Aekplakorn W,
Afsana K, Aguilar-
Salinas CA,
Agyemang C.
Worldwide trends in
body-mass index,
underweight,
overweight, and
obesity from 1975 to
2016: a pooled
analysis of 2416

4NARRATIVE REVIEW
population-based
measurement studies
in 128· 9 million
children,
adolescents, and
adults. The Lancet.
2017 Dec
16;390(10113):2627
-42.
7. Pischon T, Nimptsch
K, editors. Obesity
and Cancer.
Springer; 2016 Dec
1.

5NARRATIVE REVIEW
Other search
terms which
relate to
your
population
Other search terms You might
want to list
certain ones?
Other factors Public health initiative
etc,
Indian,
Ethnicity in
India, Indian
demography.
Overweight, prevalence of
obesity, intervention of
obesity, risk factors of obesity,
genetics and obesity.
Diabetes,
cardiovascular
risk,
respiratory
disorder,
cancer
Poverty, education,
lack of nutrition.
Healthy diet, physical
activity, change
lifestyle.
Name of database: PubMed
Ethnic
Indian
Obesity Risk Factors Factors that influence
the risk factors
Interventions Hits First
screen:
Second
screen:

6NARRATIVE REVIEW
population Hits
(Abstract)
Quality:
Hits
None 1. Kraschnewski JL,
Sciamanna CN,
Stuckey HL, Chuang
CH, Lehman EB,
Hwang KO,
Sherwood LL,
Nembhard HB. A
silent response to the
obesity epidemic:
decline in US
physician weight
counseling. Medical
care. 2013 Feb
Severe health
condition and
death.
Income, smoking,
diet, alcohol intake,
genetic factors..
Socioeconomic
intervention, providing
knowledge, introduce
clinical interventions,
create awareness.
28 13 15

7NARRATIVE REVIEW
1;51(2):186-92.
2. Unnikrishnan AG,
Kalra S, Garg MK.
Preventing obesity
in India: Weighing
the options. Indian
journal of
endocrinology and
metabolism. 2012
Jan;16(1):4.
3. Apovian CM, Gokce
N. Obesity and
cardiovascular
disease. Circulation.
2012 Mar
6;125(9):1178-82.
4. Smith KB, Smith

8NARRATIVE REVIEW
MS. Obesity
statistics. Primary
Care: Clinics in
office practice. 2016
Mar 1;43(1):121-35.
5. CFlegal KM, Carroll
MD, Kit BK, Ogden
CL. Prevalence of
obesity and trends in
the distribution of
body mass index
among US adults,
1999-2010. Jama.
2012 Feb
1;307(5):491-7.
6. Flegal KM, Kit BK,
Orpana H, Graubard

9NARRATIVE REVIEW
BI. Association of
all-cause mortality
with overweight and
obesity using
standard body mass
index categories: a
systematic review
and meta-analysis.
Jama. 2013 Jan
2;309(1):71-82.
7. Malik VS, Willett
WC, Hu FB. Global
obesity: trends, risk
factors and policy
implications. Nature
Reviews
Endocrinology. 2013

10NARRATIVE REVIEW
Jan;9(1):13.
8. Ranjani H, Mehreen
TS, Pradeepa R,
Anjana RM, Garg R,
Anand K, Mohan V.
Epidemiology of
childhood
overweight &
obesity in India: A
systematic review.
The Indian journal
of medical research.
2016
Feb;143(2):160.
9. Cheung WW, Mao
P. Recent advances
in obesity: genetics

11NARRATIVE REVIEW
and beyond. ISRN
endocrinology. 2012
Mar 5;2012.
10. Xia Q, Grant SF.
The genetics of
human obesity.
Annals of the New
York Academy of
Sciences. 2013 Apr
1;1281(1):178-90.
11. Johnson CL,
Paulose-Ram R,
Ogden CL, Carroll
MD, Kruszan-Moran
D, Dohrmann SM,
Curtin LR. National
health and nutrition

12NARRATIVE REVIEW
examination survey.
Analytic guidelines,
1999-2010.
12. Bastien M, Poirier P,
Lemieux I, Després
JP. Overview of
epidemiology and
contribution of
obesity to
cardiovascular
disease. Progress in
cardiovascular
diseases. 2014 Jan
1;56(4):369-81.
13. Bahammam AS,
AL‐JAWDER SE.
Managing acute

13NARRATIVE REVIEW
respiratory
decompensation in
the morbidly obese.
Respirology. 2012
Jul;17(5):759-71.
14. nop M, Foufelle F,
Velloso LA.
Endoplasmic
reticulum stress,
obesity and diabetes.
Trends in molecular
medicine. 2012 Jan
1;18(1):59-68.
15. Guthman J. Opening
up the black box of
the body in
geographical obesity

14NARRATIVE REVIEW
research: Toward a
critical political
ecology of fat.
Annals of the
Association of
American
Geographers. 2012
Sep 1;102(5):951-7.
Other search
terms which
relate to
your
population
Indian
Other search terms You might
want to list
certain ones?
Other factors Public health initiative
etc,
Overweight, risk of obesity,
prevalence of obesity in India,
interventions for obesity,
Diabetes,
cardiovascular
risk,
Poverty, education,
lack of nutrition.
Proper diet, physical
exercise and other
activities, change

15NARRATIVE REVIEW
public health interventions. respiratory
disorder,
cancer
lifestyle. Such as food
habits and reduce
smoking.

Running head: NARRATIVE REVIEW
Action Plan:
Research
Activities
15th
July-
20th
July
21st
July-
31st
July
1st
Aug-
5th
Aug
6th
Aug-
12th
aug
13th
Aug-
20th
Aug
20th
Aug-
31st
Aug
selection of
Research
topic
Literature
Review
Data
collection
Data analysis
Final
Research
thesis
4. Discussion on the information provided by above literatures:
The following paper will discuss about the result that means the information gathered
from the literatures mentioned above in the chart.
4.1 Definition of Obesity:
Obesity is a health condition which is caused by excessive accumulation of fat in
individual. Some researchers have informed that obesity is a condition of abnormal body weight
which is normally more than 20% and above the average weight according to particular age,
height and structure of bone. It has been also elaborated by the researcher that obesity is a severe

1NARRATIVE REVIEW
health condition during which body accumulates excessive fat that could lead to adverse effect
and severe health issues (9). It has been reported by a study that the most acceptable clinical
definition of obesity is abnormal increase in body weight (10). The definition is still used but it is
not the accurate measure of obesity. Height and weight tool is one of the most popular tools to
measure obesity; however, it could not explain the specificity or degree of obesity within a
patient. It has been found that, BMI is closely related to the grades of obesity and effective in
case of measuring obesity (11).
4.2 Types of Obesity:
Healthy weight varies according to the age and sex. Obesity is not considered as the
absolute number but with respect to a normal historical group it is refer to the BMI greater than
30. The percentiles based on the data of 95th percentile from 1963 to 1994. Thus, the data have
not been considered the increase in weight in recent year. The different types of obesity are
classified below (12).
Classification BMI (kg/m2)
Underweight < 18.50
Normal weight 18.50–24.99
Overweight 25.00–29.99
Class I obesity 30.00–34.99
Class II obesity 35.00–39.99
Class III obesity ≥ 40.00
4.3 Assessment of Obesity:

2NARRATIVE REVIEW
Research has indicated that assessment of obesity can be conducted in 4 ways-
 Firstly the visual inspection which is a simple method but not accurate or precise.
 The second method is related to measurement of standard weight and height.
 The third method is known as BMI method that defines the Body Mass Index of
individual and evaluates fat distribution through waist-hip ratio and the risk
factors of cardiovascular disease. In this process the weight of the subject is
divided by the square of the height and it is measured as follow-
 BMI ≥ 35 or 40 kg/m2 is considered as severe obesity.
 BMI ≥40–44.9 kg/m2 and occurrence of obesity related severe health issue
is considered as morbid obesity.
 BMI ≥ 45 or 50 kg/m2 is considered as super obesity.
 The fourth method includes skin fold thickness method that estimates fat
distribution in the body (13).
Such processes are helpful in the assessment of obesity and the processes provide
effective result that helps to understand and measure the prevalence of obesity in a population.
4.4 Etiology:
The primary causes of obesity has been identified as being the environmental, physical,
behavioral factors along with the social and cultural factors that leads to imbalance in energy and
deposition of excessive fat in the body of the individual. There has been an increased rate of
occurrence of obesity primarily due to the sedentary lifestyle of the individuals along with the
energy intake in excessive amount. Other factors that are identified include sleep deprivation,
several endocrine disruptors that are environmental pollutants and reduced variability in

3NARRATIVE REVIEW
optimum temperature (14). Elevated use of medications is also responsible for causing weight
gain especially in cases like atypical antipsychotics. Often late pregnancy might lead to
susceptibility of obesity in children including the epigenetic risk factors that are inherited in a
generation wise manner (15)
Intake of unbalanced diet results in obesity since often the fat consumption is high in the
diet. The selection of higher Body Mass Index (BMI), and assortative mating might lead to more
focus of obesity risk factors. By the year of 2006, it was reported that 41 or more human genome
sites have been related to obesity development, in an auspicious environment. People possessing
two copies of the FTO gene (fat mass and obesity associated gene) have been identified to weigh
3–4 kg or more, having a 1.67 fold higher risk of obesity in comparison to the people that does
not carry any the mutated allele (16)
4.5 Complications of Obesity:
Several syndromes that occur in humans like the Prader–Willi syndrome and the Cohen
syndrome, a major characteristic feature of these syndromes is obesity. Individuals who suffer
from early onset of obesity, they tend to possess a single point DNA mutation in most of the
cases (17). A study conducted by Data related to children and adolescents, it showed cross-
sectional nationally representative US surveys: cycles II and III of the National Health
Examination Survey (1963–1965 and 1966–1970). The first, second, and third National Health
and Nutrition Examination Surveys: NHANES I (1971–1974), II (1976–1980), and III (1988–
1994) (18). Three of these methods that were implemented were seen to provide results of
similar nature however the results were not identical. In case of children, the reference values
were lower in estimation as compared to the CDC-US growth charts (American). Research has

4NARRATIVE REVIEW
indicated that obesity may leads to various severe health issues that could lead to death. For
example, cardiovascular risk is one of the most common issues that have been found in obese
people (19). A major portion of people that are suffering from obesity has been found to suffer
from respiratory disorder as well (20). Diabetes is also associated with obesity (21). Cancer is
another severe consequence of obesity that is one of the biggest threats to the health status of the
population (22).
Reports have shown that, more than 10% of the total population of the world who were
adults was identified as obese. In the year of 2013, it was reported that about 42 million of
children around the world were obese overweight. However in recent times it is seen that it
equally affects the population of the countries belonging to low- and middle-income, especially
in the urban population (23).
5. Limitation:
It has been found that there are limitations of the study in terms that the review was done
single headedly by an individual researcher therefore there might be some biasness regarding the
interpretation of the results. Most of the studies that was conducted included a cross-sectional
research approach. Often narrative reviews can lead to misleading results. Often due to scarcity
of evidences there might be loss of credibility of the data that is collected and further analyzed.
The research paper that are selected for the narrative review have provided effective data and
information regarding the prevalence of obesity in India. It has provided relevant evidence for
supporting the findings. Factors that influence obesity in the population have been identified.
Barriers are creating obstacles in the way of effective interventions have been mentioned.
However, the research carried out for the narrative review has not provided adequate information

5NARRATIVE REVIEW
regarding a specific factor such as genetics. Role of FTO gene in obesity has been identified but
there are other factors related to genetics that are not identified by the study. Genetic
transformation of obesity from parents to children and the types of genes responsible for such
incident are not mentioned in the study. Further research is needed to elaborate the genetic
factors in depth.

6NARRATIVE REVIEW
References:
1. Kraschnewski JL, Sciamanna CN, Stuckey HL, Chuang CH, Lehman EB, Hwang
KO, Sherwood LL, Nembhard HB. A silent response to the obesity epidemic: decline
in US physician weight counseling. Medical care. 2013 Feb 1;51(2):186-92. pubmed
2. Unnikrishnan AG, Kalra S, Garg MK. Preventing obesity in India: Weighing the
options. Indian journal of endocrinology and metabolism. 2012 Jan;16(1):4. pub
3. Cohn BS. Notes on the History of the Study of Indian Society and Culture.
InStructure and change in Indian society 2017 Nov 13 (pp. 3-28). Routledge.
4. Kalra S, Unnikrishnan AG. Obesity in India: The weight of the nation. Journal of
Medical Nutrition and Nutraceuticals. 2012 Jan 1;1(1):37.
5. Apovian CM, Gokce N. Obesity and cardiovascular disease. Circulation. 2012 Mar
6;125(9):1178-82. pub
6. Smith KB, Smith MS. Obesity statistics. Primary Care: Clinics in office practice.
2016 Mar 1;43(1):121-35. pub
7. Youngson NA, Morris MJ. What obesity research tells us about epigenetic
mechanisms. Phil. Trans. R. Soc. B. 2013 Jan 5;368(1609):20110337.
8. Carvajal R, Wadden TA, Tsai AG, Peck K, Moran CH. Managing obesity in primary
care practice: a narrative review. Annals of the New York Academy of Sciences.
2013 Apr;1281(1):191-206.
9. Wright J, Harwood V, editors. Biopolitics and the'obesity epidemic': governing
bodies. Routledge; 2012 Mar 22.

7NARRATIVE REVIEW
10. Wright J. Biopower, biopedagogies and the obesity epidemic. InBiopolitics and
the'Obesity Epidemic' 2012 Mar 22 (pp. 9-22). Routledge.
11. CFlegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the
distribution of body mass index among US adults, 1999-2010. Jama. 2012 Feb
1;307(5):491-7.pub
12. Flegal KM, Kit BK, Orpana H, Graubard BI. Association of all-cause mortality with
overweight and obesity using standard body mass index categories: a systematic
review and meta-analysis. Jama. 2013 Jan 2;309(1):71-82. pub
13. Abarca-Gómez L, Abdeen ZA, Hamid ZA, Abu-Rmeileh NM, Acosta-Cazares B,
Acuin C, Adams RJ, Aekplakorn W, Afsana K, Aguilar-Salinas CA, Agyemang C.
Worldwide trends in body-mass index, underweight, overweight, and obesity from
1975 to 2016: a pooled analysis of 2416 population-based measurement studies in
128· 9 million children, adolescents, and adults. The Lancet. 2017 Dec
16;390(10113):2627-42.
14. Malik VS, Willett WC, Hu FB. Global obesity: trends, risk factors and policy
implications. Nature Reviews Endocrinology. 2013 Jan;9(1):13. pub
15. Ranjani H, Mehreen TS, Pradeepa R, Anjana RM, Garg R, Anand K, Mohan V.
Epidemiology of childhood overweight & obesity in India: A systematic review. The
Indian journal of medical research. 2016 Feb;143(2):160. pub
16. Cheung WW, Mao P. Recent advances in obesity: genetics and beyond. ISRN
endocrinology. 2012 Mar 5;2012. pub
17. Xia Q, Grant SF. The genetics of human obesity. Annals of the New York Academy
of Sciences. 2013 Apr 1;1281(1):178-90. pub

8NARRATIVE REVIEW
18. Johnson CL, Paulose-Ram R, Ogden CL, Carroll MD, Kruszan-Moran D, Dohrmann
SM, Curtin LR. National health and nutrition examination survey. Analytic
guidelines, 1999-2010. pub
19. Bastien M, Poirier P, Lemieux I, Després JP. Overview of epidemiology and
contribution of obesity to cardiovascular disease. Progress in cardiovascular diseases.
2014 Jan 1;56(4):369-81. pub
20. Bahammam AS, AL‐JAWDER SE. Managing acute respiratory decompensation in
the morbidly obese. Respirology. 2012 Jul;17(5):759-71. pub
21. nop M, Foufelle F, Velloso LA. Endoplasmic reticulum stress, obesity and diabetes.
Trends in molecular medicine. 2012 Jan 1;18(1):59-68. pub
22. Pischon T, Nimptsch K, editors. Obesity and Cancer. Springer; 2016 Dec 1.
23. Guthman J. Opening up the black box of the body in geographical obesity research:
Toward a critical political ecology of fat. Annals of the Association of American
Geographers. 2012 Sep 1;102(5):951-7.pub