Review Article: Herbal Approach for Obesity Management

Abstract

Obesity, a complex interplay between environmental and genetic factors and is associated with significant morbidity and mortality. Usage of herbs for the management of obesity in the recent times is attracting attention. A web and manual based literature survey was conducted to assess the amount of information available on the herbal products for weight management. Traditional literature, PubMed, Scopus, Google scholar databases were screened up to February 2012. The search words were “obesity", "herbal medicine/products/extracts”, "medicinal plants", "traditional medicine", "Ayurvedic medicine" without narrowing/limiting searching words or elements. Publications only with abstracts/full articles and books were reviewed in the search. Based on the available literature, for many of the herbal and weight loss products, there is little published information and there have been no clinical trials or the level of evidence is limited. Our literature survey also indicated that these herbal products fall under an acceptable level of evidence or with no scientific background at all, or they have a scientific rational but not to an acceptance level. Attempts were made in the review to define the features of possible herbal weight loss product. An ideal herbal anti obesity product should reduce the weight by 10% over placebo of treatment by showing an evidence of improvement of bio markers like blood pressure, lipids and glycemia without any side effects.

Full text

American Journal of Plant Sciences, 2012, 3, 1003-1014
doi:10.4236/ajps.2012.327119 Published Online July 2012 (http://www.SciRP.org/journal/ajps) 1003
Review Article: Herbal Approach for Obesity Management
C. V. Chandrasekaran1,2*, M. A. Vijayalakshmi2, K. Prakash1, V. S. Bansal2, J. Meenakshi1,
A. Amit1
1R&D Centre, 5B, Veerasandra Industrial Area, Natural Remedies Pvt. Ltd., Bangalore, India; 2Center for Bioseparation Technology,
VIT University, Vellore, India.
Email: *cvc@naturalremedy.com, cvctox@gmail.com
Received May 1st, 2012; revised May 30th, 2012; accepted June 10th, 2012
ABSTRACT
Obesity, a complex interplay between environmental and genetic factors and is associated with significant morbidity
and mortality. Usage of herbs for the management of obesity in the recent times is attracting attention. A web and man-
ual based literature survey was conducted to assess the amount of information available on the herbal products for
weight management. Traditional literature, PubMed, Scopus, Google scholar databases were screened up to February
2012. The search words were “obesity”, “herbal medicine/products/extracts”, “medicinal plants”, “traditional medicine”,
“Ayurvedic medicine” without narrowing/limiting searching words or elements. Publications only with abstracts/full
articles and books were reviewed in the search. Based on the available literature, for many of the herbal and weight loss
products, there is little published information and there have been no clinical trials or the level of evidence is limited.
Our literature survey also indicated that these herbal products fall under an acceptable level of evidence or with no sci-
entific background at all, or they have a scientific rational but not to an acceptance level. Attempts were made in the
review to define the features of possible herbal weight loss product. An ideal herbal anti obesity product should reduce
the weight by 10% over placebo of treatment by showing an evidence of improvement of bio markers like blood pres-
sure, lipids and glycemia without any side effects.
Keywords: Morbidity; Ayurveda; Obesity; Literature Survey; Medicinal Plants; Herbal Products; Weight Management
1. Introduction
Accumulation of fat over the limit led to ill/adverse ef-
fect in the body known as obesity. Body mass index
(BMI) is an index of weight-for-height that is commonly
used to classify overweight and obesity in adults. The
World Health Organization (WHO) definition is: 1) A
BMI greater than or equal to 25 is overweight and, 2) A
BMI greater than or equal to 30 is obesity. BMI provides
useful population-level measure of overweight and obe-
sity as it is the same for both sexes and for all ages of
adults. However, it should be considered as rough guid-
ance because it may not correspond to the same degree of
fatness in different individuals.
Obesity and overweight occurs due to imbalance be-
tween calories consumed and calories utilized. Globally,
there have been two reasons for overweight and obesity:
1) an increased intake of energy-dense foods that are
high in fat, salt and sugars but low in vitamins, minerals
and other micronutrients; and, 2) a decrease in physical
activity due to the increasingly sedentary nature of many
forms of work, changing modes of transportation, and
increasing urbanization [1,2]. Changes in dietary and
physical activity patterns are often results from sedentary
lifestyle, not sleeping enough, endocrine disruptors, such
as some foods that interfere with lipid metabolism, medi-
cations that make patients put on weight, medical and
psychiatric illness and infectious agents.
Overweight and obesity are the fifth leading risk for
global deaths. At least, 2.8 million adults die each year as
a result of being overweight or obese. In addition, 44%
of the diabetes burden, 23% of the ischaemic heart dis-
ease burden and between 7% and 41% of certain cancer
burdens are attributable to overweight and obesity. WHO
global estimates for the year 2008, reported 1.5 billion
people were overweight, of these, over 200 million men
and nearly 300 million women were obese. Overall, more
than one in ten of the world’s adult population was obese
[1,3].
In 2010, around 43 million children under five were
overweight. Overweight and obesity are now on the rise
in low and middle income countries, particularly in urban
settings. Close to 35 million overweight children are liv-
ing in developing countries and 8 million in developed
countries. Childhood obesity is associated with a higher
*Corresponding author.
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Review Article: Herbal Approach for Obesity Management
1004
chance of obesity, premature death and disability in
adulthood. But in addition to increased future risks, obese
children experience breathing difficulties, increased risk
of fractures, hypertension, cardiovascular diseases and
psychological effects [4].
Overweight and obesity are linked to more deaths
worldwide than underweight. For an example, 65% of
the world’s population live in countries where overweight
and obesity kill more people than underweight (this in-
cludes all high-income and most middle-income coun-
tries). Obesity is a major health threat. The extra weight
puts added stress on every part of individual’s body.
People with obesity are at risk for these health problems:
Bone and joint problems due to extra weight puts strain
on the bones and joints. This can lead to osteoarthritis, a
disease that causes joint pain and stiffness, gallstones and
liver problems, heart attack from coronary heart disease,
congestive heart failure, and stroke, high blood choles-
terol and triglycerides (dislipidemia or high blood fats),
high blood pressure (hypertension), high blood sugar
(glucose) or diabetes, stopping breathing during sleep
(sleep apnea). This can cause daytime fatigue or sleepi-
ness, poor attention, and problems at work.
Obesity is recognized as the most crucial risk factor
for type 2 diabetes. Obesity, in particular intraabdominal
adiposity, is associated with increased free fatty acid
(FFA) concentrations in blood plasma which exercise a
major negative effect on insulin sensitivity in both mus-
cle and liver. Besides insulin resistance, defective insulin
secretion is a prerequisite for the development of type 2
diabetes. Both lipotoxicity and glucotoxicity may initiate
and enable a vicious circle dependable for the metabolic
impairment. Diabetes occurs as a late phenomenon in
obesity and is preceded by years of impaired glucose
tolerance. The progression to diabetes is indicated by an
inability of the B cells of pancreatic langerhans to main-
tain its high rate of insulin secretion in response to glu-
cose in face of insulin resistance [5]. The partial reversi-
bility of the evolution of obesity towards diabetes is well
demonstrated today by lifestyle changes and multidisci-
plinary weight loss programs [6]. Nature is enriched with
plant wealth for all living creatures, which possess me-
dicinal virtues [7]. Anti diabetic activity has been re-
ported in many plants during the last couple of years.
Moreover, their mechanism of action differs from that of
insulin in that they appear to act as anti-metabolites, ca-
pable of blocking the pathway of oxidation of fatty acids.
Approximately 343 plants of the world have been tested
for the blood glucose which found lowering effect in the
laboratory experiments. Of them, 158 species are claimed
to be used in traditional system on Indian medicine [8].
The chief goal of obesity treatment is to maintain
healthy weight. The treatment method to be undertaken
often depends on the preferred choice of an individual
undergoing treatment as well as the level of obesity.
Common treatment measures include the following me-
thods, dietary changes, exercise and activity, behavior
change, prescription weight-loss medications and weight-
loss surgery [2].
The preferred treatment modality for weight loss is di-
eting and physical exercise. But due to busy schedules
and sedentary lifestyle follow-up the first two methods
never seems to be practiced in a regular manner. On the
other hand weight loss surgery runs out of the option
considering the cost involved. There is a gradual shift
towards an increase use of drugs. Drugs are pharmacol-
ogical agents that reduce or control weight. These drugs
alter one of the fundamental processes of the human
body, weight regulation, by altering appetite, metabolism,
or absorption of calories. Only one anti-obesity medica-
tions orlistat is currently approved by the FDA for long
term use. It reduces intestinal fat absorption by inhibiting
pancreatic lipase [3]. Rimonabant, a second drug often
referred to as “the munchies”, had been approved in
Europe for the treatment of obesity but has not received
approval in the United States and Canada due to safety
concerns [9]. Sibutramine, which acts on the brain to
inhibit deactivation of the neurotransmitters, thereby de-
creasing appetite was withdrawn from the United States
and Canadian markets in October 2010 due to cardio-
vascular side effects [6]. Because of potential side effects,
it is recommended that anti-obesity drugs only be pre-
scribed for obesity where it is hoped that the benefits of
the treatment outweigh its risk [10].
The use of allopathic and pharmacological drugs has
become a popular means to overcome excess weight gain
[11]. While these drugs generally are effective, severe
adverse toxicities may limit their overall usefulness [12,
13]. A nutritional based intervention is being hailed as an
inexpensive alternative to aid weight loss, and weight
management [14]. Medicinal herbal supplements are be-
ing extensively utilized due to their effectiveness in
managing many chronic disorders. They are cost-effec-
tive, and exert less to no toxic side-effects in comparison
with many chemically synthesized drugs [15]. Accord-
ingly, recent preliminary reports suggested that herbs
with a long history of use and other natural substances
less likely to produce severe toxicity might be effective
in reducing appetite and promoting significant weight
loss are encouraging [16].
2. Obesity and Psychiatric Co-Morbidity
The evidence for the interplay between certain mental
illnesses (binge-eating, anxiety, mood disorders) and
obesity is bidirectional [17]. Various demographical groups
suggest that social or cultural factors may moderate or
mediate the association between obesity and mood dis-
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Review Article: Herbal Approach for Obesity Management 1005
orders. Population with a psychiatric disorder is at higher
risk for overweight and obesity than healthy ones [18-20].
At present there is no clear link concluded between obe-
sity and psychopathology, and whether the possible psy-
chological disorders are a cause or a consequence of
obesity has not yet been clarified either [21]. Studies do
portrays that certain psychological disorders seem to be
more common in obese people, such as depression, anxi-
ety, substance abuse, etc., although the direction of the
explanatory relation is not clear; moreover, the opposite
result has also been found [22]. Furthermore, there are
studies which determine high prevalence rates of mental
disorders in obese patients seeking treatment, suggesting
the psychiatric evaluation of obese patients as a routine
practice [23].
The mere evidences of likely co morbid psychopa-
thology means that the practitioner must consider its as-
sessment in obesity cases, and include a plan for a psy-
chiatric and/or psychological therapeutic intervention.
Over the past decade, there has been a great increase in
the use of complementary treatment such as herbal reme-
dies for relieving the psychiatric symptoms of obesity
and the related morbidities [21,22]. Lee et al. has sug-
gested the use of Ob-X, a mixture of three herbs Melissa
officinalis L. (Labiatae), Morus alba L. (Moraceae), and
Artemisia capillaris Thunb. (Compositae) for regulating
hyperlipidemia [23].
3. Herbs Recommended for Obesity
Evidences are emerging to support that an increasing
consumption of herbs are effective strategy for obesity
control and weight management. Usage of plants and
plant products has potential to keep the increasing preva-
lence of metabolic syndrome in control. There are few
drugs in the market to prevent/manage obesity but there
are the costs, efficacy and side effects to consider. For
centuries people across the countries have been using
natural products as plant based dietary supplements for
weight control [24].
4. Traditional Medicine and Obesity
Ayurveda (Ayur = life, Veda = knowledge), which is
“Science of Life”, originated from the Vedic times and is
a part of holistic health care system. The chief source of
ancient Indian Aryan culture and medicine are the four
Vedas that are traditionally believed to be revealed to the
sages by Brahma (the creator) some 6000 years before
Christian era. Ayurveda’s primary emphasis is on pres-
ervation and promotion of health, it also provides treat-
ment for disease. Many undesirable constitutions (about
eight) in the body are mentioned in “Charaka Samhita”,
an authentic source of ayurveda. Obesity or “Medoroga”
is one among them. It is said that it is comparatively easy
to help an underweight person, rather than an overweight
person. The overweight problem can be due to an actual
increase in the fat component (Meda Dhatu), or it can be
due to malfunctioning. These, accordingly, will need
different approaches. In very few cases it can be an off-
shoot of other metabolic disorders. We have reviewed the
available ayurvedic/traditional texts books [25-28] for
searching plants which are indicated for obesity. The
detailed list of plants has been depicted in Table 1.
5. Modern Literature and Obesity
A huge number of herbal supplements are currently pre-
sent in the market for the management of obesity, al-
though not all of them have the same effect, reason being,
supplements targeting different molecules thereby fol-
lowing unique mechanism of action varying completely
from the other. The basic principle underlying the mode
of action of anti-obesity supplements is regulating the
energy balance in the body, which is the balance between
energy intake and expenditure. For the convenience of
explaining/understanding different studies follow differ-
ent approaches of categorizing the mechanism, either on
the basis of the effect of the drug on nervous system or
the effect of a supplement on physiological functions/
behavior.
Ample of review on anti-obesity supplements have
categorized their mechanism of action primarily on the
basis of the activity they regulate. For an example, Yun
et al. [29] classified the mechanism of anti-obesity action
of natural supplements on the basis of the effect they
produce 1) decreased lipid absorption, 2) decreased en-
ergy intake, 3) increased energy expenditure, 4) decreased
pre-adipocyte differentiation and proliferation, or 5) de-
creased lipogenesis and increased lipolysis. For covering
the broader range as well as for the convenience of un-
derstanding, Saper et al. [30] classified the mechanism of
action of anti-obesity product on the basis of: 1) Increase
energy expenditure, 2) Modulation of carbohydrate me-
tabolism, 3) Increase satiety, 4) Increase fat oxidation or
reduced fat synthesis, 5) Block dietary fat absorption, 6)
Increased water elimination, 7) Enhance mood, 8) Mis-
cellaneous and unspecified. We observed that there is
plethora of literature on the mechanism of action of syn-
thetic compounds along with convincing number of
clinical studies to stand its safety, but continuous with-
drawal of the major drugs (USFDA approved) due to the
ill effects [31], paved a way for the growth of dietary
supplements as a safe option to cure obesity. At the same
time the available literature on mechanism of action of
drugs will definitely decrypt the likely molecules and the
molecular mechanism by which the active phyto-com-
pounds act on. Like a drug, supplements also can act
peripherally, centrally or in combination (peripherally &
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Review Article: Herbal Approach for Obesity Management
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Table 1. List of herbs indicated for obesity in ayurveda text
books.
Botanical name Sanskrit/official
name Part(s) used
Acacia arabica Babbula Gum, bark, leaf,
fruit-pods
Acacia catechu Khadira bark, heartwood, flower
Achyranthus aspera Apamarga Root, seed, leaf,
whole plant
Aconitum heterophyllum Ativisha Root, rhizome
Acorus calamus Vacha Rhizome
Adathoda vasica Vasa Leaf, root, flower
Aloe vera Kumari Leaf, root
Alstonia scholaris Saptaparna Bark, latex, flower
Ananas comosus Ananas Fruit
Anthocephalus chinensis Kadamba Bark, leaf, fruit, root
Azadirachta indica Nimba All parts
Berberis aristata Daruharidra Root, stem, fruit
Betula utilis Burja Bark, nodes
Calatropis gigantea Arka Root, bark, flower, leaf,
latex, seed
Calicarpa macrophylla Priyangu Flower, leaf
Capsicum annuum Kutavira Fruit
Cassia tora Chakramardha Seed, leaf, root
Cedrus deodara Devadaru Heartwood oil
Cinnamomum zeylanicum Twak Bark, leaf, oil
Cissampelos pareira Patha Root, stem
Clerodendrum phlomidis Agnimantha Root, bark, leaf
Cocus nucifera Narikela Fruit, flower, oil, root
Commiphora Mukul Guggulu Gum-resin
Coriandum sativum Dhanyaka Whole plant, leaf, fruit
Costus speciosus Kebuka Rhizome
Cuminum cyminium Jeeraka Seed
Curcuma longa Haridra Rhizome
Desmostachya bipinnata Kusa Root
Dolichos biflorus Kulatta Seed
Embelia ribes Vidanga Fruit
Emblica officinalis Amalaki Fruit
Euphobia nerifolia Snuhi Latex, stem, leaf, root
Ferula nortex Hingu Oleo-gum resin
Ficus Glomerata Udumbara Bark, fruit, latex
Continued
Ficus lacor Plaksha Bark
Ficus religiosa Ashwattha Bark, fruit, leaf
Ficus rumphii Asmanthaka Stem, bark, latex, fruit
Garcinia indica Vrikshamla Fruit, root, bark, oil
Gymnema sylvestre Meshashringi Leaf, root, seed
Holarrhena antidysentrica Kutaja Seed, bark
Innula racemosa Pushkaramula Root
Marsdenia tenacissima Murva Root
Momordica charantia Karavellaka Fruit, whole plant,
leaf, root
Moringa oleifera Sigru Root, bark, seed
Ougenia dalbergioides Tinisa Heart wood
Picrorhiza kurroa Katuka Root
Piper chaba Chavya Root, fruit
Piper longum Pippali Fruit, root
Piper nigrum Maricha Fruit
Plumbago zeylanica Chitraka Root, bark
Pongamia pinnata Karanja Fruit, seed, oil, root
Pterocarpus marsupeum Bijaka Heart wood
Randia dumetorum Madanaphala Fruit
Santalum album Candana Heartwood
Saussurea lappa Kushta Root
Sphaeranthus indicus Munditaka Whole plant
Stereosprmum sauvealens Patala Root, bark, flower,
seed, leaf
Symplocos racemosa Lodhra Bark
Terminalia arjuna Arjuna Bark, root, leaf
Terminalia bellerica Bibhitaka fruit
Terminalia chebula Haritaki fruit
Terminalia tomentosa Asana Bark, heartwood
Thea sinensis Oolong tea Leaf
Tinospora cordifolia Guduchi Stem, root
Trachyspermum ammi Yavani Fruit
Tragia involucrata Yavasa Whole plant
Tribulus terrestris Gokshura Fruit, root, whole plant
Trigonella foenum graceum Methika Seed, leaf, whole plant
Valeriana jatamansi Tagara Root
Zingiber officinale Shunti Rhizome
Ziziphus mauritiana Badara Root, leaf, fruit
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Review Article: Herbal Approach for Obesity Management 1007
central) on the receptors of the nervous system, thereby
managing appetite, metabolism (lipid and carbohydrate)
or caloric absorption.
In the present review, we surveyed the natural prod-
ucts with anti-obesity potential and reviewed the scien-
tific data, including experimental methodologies, active
components, and mechanisms of action against obesity.
We classified the mechanism of action of herbs viz., 1)
Peripherally acting and 2) Centrally acting
5.1. Peripherally Acting Mechanism
Substances acting peripherally, mediate their effects by
reducing the calorie absorption in the gastrointestinal
system or by affecting metabolic and/or control systems
outside the central nervous system (CNS). One of the
way to reduce energy intake is through gastrointestinal
mechanisms such as nutrients digestion and absorption
[32].
5.1.1. Lipase Inhibition
Dietary fat is not directly absorbed by the intestine unless
the fat has been subjected to the action of pancreatic li-
pase. Therefore, pancreatic lipase is one of the most
widely studied mechanisms for determining natural prod-
ucts’ potential efficacy as anti-obesity agents [32]. Sup-
plement acts in the gut lumen by forming a covalent
bond with the active serine site of gastric and pancreatic
lipases. By forming the covalent bond, it inhibits these
lipases from hydrolyzing the ingested fat into absorbable
free fatty acids and monoglycerides. The decreased ab-
sorption of ingested fat leads to an overall decreased ca-
loric absorption, in turn leading to weight loss [33].
A wide variety of plants possess pancreatic lipase in-
hibitory effects, including Panax japonicus [34], Platy-
codi radix [35], Salacia reticulata [36], Nelumbo nucifera
[37]. These pancreatic lipase inhibitory phytochemicals
include mainly saponins, polyphenols, flavonoids, and
caffeine [38-40]. The most studied natural sources of
pancreatic lipase inhibitors are derived from different
types of tea (e.g. green, oolong, and black tea). A sig-
nificantly different type of polyphenols isolated from tea
leaves, showed strong inhibitory activity towards pancre-
atic lipase [41- 43]. These polyphenols require galloyl
moieties within their chemical structures and/or polym-
erization of their flavan-3-ols for enhanced pancreatic
lipase inhibition [42].
5.1.2. Adipogenesis down Regulation
Energy balance and lipid homeostasis is maintained in
the body by specialized cells called as adipocytes. Adi-
pocytes primarily store triglycerides and release them in
the form of free fatty acid with the change of energy de-
mand in the body [44].
Adipogenesis is a complex process regulated by the
expression of several hundred genes. The primary adi-
pogenic transcription factors involved in adipocyte dif-
ferentiation belongs to the peroxisome proliferator acti-
vator receptor (PPAR), C/EBP, and sterol regulatory ele-
ment binding protein (SREBP) families. PPAR-γ expres-
sion during differentiation is an important event in adi-
pogenesis process in fat cells [45]. Polyunsaturated fatty
acids (PUFAs), a vital components of the phospholipids
of cell membranes and acts as a signal transducer regu-
lating adipocyte-specific gene expression involved in
lipid metabolism and adipogenesis [46]. Various phyto-
chemicals like quercetin, kaempferol and catechin and
dietary flavonoids found in vegetables, fruits, green tea
and herbs are reported to down-regulate the adipogene-
sis-related transcriptional factors PPAR-γ, C/EBP-α and
SREBP-1 and to inhibit adipocyte differentiation during
the early stage. Tea catechins and epigallocatechin gallate
(EGCG) decreased the weight of subject adipose tissue
[47-50].
In addition to showing inhibitory activity against adi-
pocyte differentiation, several naturally-occurring com-
pounds have displayed apoptotic effects on maturing pre-
adipocytes, e.g. phytochemicals, such as esculetin, res-
veratrol, quercetin, genistein, capsaicin, and conjugated
linoleic acids induced apoptosis of maturing 3T3-L1 pre-
adipocytes through suppression of ERK1/2 phosphoryla-
tion, activation of the mitochondrial pathway, AMPK
activation, or anti-oxidant activity [51-55]. Sirtuin 1 is
another target molecule for anti-obesity treatment. De-
creased adipogenesis due to resveratrol correlated with
increased expression of Sirtuin1, which promotes fat
mobilization by repressing PPARc [56,57].
5.1.3. Thermogenesis
Excessive adiposity results from an imbalance in energy
homeostasis as a result of excessive food intake are not
balanced by increased energy expenditure [58,59]. To
regulate body weight and energy expenditure, mammal-
ian BAT (brown adipose tissues) establishes non-shiv-
ering thermogenesis through dissipation of excess energy
as heat [60]. BAT plays an important role in obesity con-
trol by controlling energy balance.
The key player in this process is UCP (Mitochondrial
uncoupling protein), which discharges the proton gradi-
ent generated in oxidative phosphorylation, thereby dis-
sipating energy as heat. Thus, searching for substances
that upregulate UCP1 gene expression may be a worthy
strategy for achieving obesity control through increased
energy expenditure [61]. Yoon et al. has shown that
ethanolic extract of Solanum tuberosum, can activate the
expression of UCP3 in BAT and the liver and signifi-
cantly reduced fat weight in HFD-fed rats [62]. Numer-
ous naturally-occurring compounds have been proposed
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Review Article: Herbal Approach for Obesity Management
1008
as treatments for weight loss via enhanced energy expen-
diture, including caffeine [63,64] and capsaicin [57,65].
5.1.4. Lipid Metabolism
The pharmacological targeting of lipolysis can be envis-
aged in two different ways. The first strategy entails
stimulating triglyceride hydrolysis in order to diminish
fat stores, thereby combating obesity. This option re-
quires the associated oxidation of the newly released
fatty acids and led to the development of the b3-adren-
ergic agonists [66]. Some examples of the natural com-
pounds involved in b3-adrenergic receptor activation are
the various flavonoids in the leaf of Nelumbo nucifera
(NN). Through this pathway, NN extract dietary supple-
mentation resulted in significant suppression of body
weight gain in A/J mice fed a HFD [67]. Caffeine, one of
the major bioactive components in oolong tea (Thea
sinensis) possesses both a positive charge and a hydro-
phobic area like that of adrenaline. Caffeine’s mecha-
nism of lipolytic action might be due to its binding to the
phospholipid phosphate groups and the subsequent in-
teractions between the lipase and triglyceride portions of
lipid droplets, eliciting lipolysis [41].
5.2. Centrally Acting Mechanisms
Body mass can also be maintained by restricting the in-
take of food. Many products act in a way through their
effect on the receptor within the central nervous system
thereby developing a sense of satiety within the body.
5.2.1. Neuropeptide Signaling Modulators
The dietary intake of humans varies routinely; still
weight remains remarkably stable in most humans be-
cause overall energy intake and expenditure are exqui-
sitely matched over long periods of time through the
process of energy homeostasis [68,69]. The status of
body energy stores is communicated to the central nerv-
ous system by the adiposity-associated hormones leptin,
insulin, and possibly selected gastrointestinal (GI) pep-
tides, such as ghrelin [69]. The arcuate nucleus of the
hypothalamus, the primary neurnal signaling site for ap-
petite regulating hormones, is mainly composed of two
types of neurons:
1) Anorexigenic (appetite suppressing) neuropeptides,
pro-opiomelanocortin (POMC) and cocaine- and am-
phetamine-regulated transcript (CART).
2) Orexigenic (appetite stimulating) neuropeptide,
agouti-related peptide (AgRP) and neuropeptide Y (NPY).
Leptin and insulin stimulate the activity of neurons
that express the neuropeptide precursor proopiomelano-
cortin (POMC), while inhibiting neurons that produce the
anabolic mediator’s neuropeptide Y (NPY) and agouti-
related protein Ghrelin exerts the opposite effects on this
circuitry, directly activating NPY/Agrp cells and thereby
indirectly silencing POMC cells. Leptin, insulin, and
ghrelin communicate with neurons in the hypothalamus
and thereby modulate appetite and energy expenditure to
regulate body weight. Leptin, Ghrelin and Neuropeptide
Y therefore pops up as a hot targets as well as marker for
obesity. Green tea extract has been reported to regulate
the plasma leptin concentration [70]. Treatments of adlay
seed crude extract (ACE) modulated expressions of
leptin and TNF-alpha and reduced body weights, food
intake, fat size, adipose tissue mass and serum hyperlipi-
demia in obesity rat fed HFD [71].
Neuropeptide Y and its many receptors, in addition to
stimulating melanocortins and other catabolic pathways,
the adiposity hormones leptin and insulin inhibit anabolic
neuropeptides, such as hypothalamic NPY, and chronic
NPY administration powerfully increases food intake and
body weight. Thus, pharmacological blockade of NPY
signaling is a potential antiobesity strategy. Many natural
appetite suppressants mediate the reduced expression of
hypothalamic neuropeptide Y (NPY) or serum leptin
levels [72]. For instance, Kim et al. [71] proved that, in
HFD-induced obesity in rats, a crude saponin of Korean
ginseng effectively regulated serum leptin and NPY ex-
pression in the rat hypothalamus. Limited number of re-
ports were published with regard to interaction of natural
substances with appetite suppressing and appetite stimu-
lating molecules.
5.2.2. Monoamine Neurotransmitters
Body weight regulation through appetite control is a mul-
tifactorial event resulting from neurological and hormo-
nal interrelationships. A line of evidence indicates that
serotonin, histamine, dopamine, and their associated re-
ceptor activities are closely associated with satiety regu-
lation. Serotonin is a monoaminergic neurotransmitter
that modulates numerous sensory, motor, and behavioral
processes, acting through a family of at least fourteen
5-HT receptor subtypes. These receptors may enable
researchers to better target their searches for drugs that
treat obesity through energy intake reduction [73]. Agents
that act via peripheral satiety peptide systems, alter the
various hypothalamic neuropeptides’ CNS levels, or alter
the key CNS appetite monoamine neurotransmitters’ lev-
els may be suitable candidates for drugs that will sup-
press appetite [74,75]. Green tea and its constituents
(catechins, such as epigallo catechin (EGC) and epigallo
catechin gallate (EGCG), have received tremendous at-
tention [76,77], as several lines of evidence suggest
EGCG to stimulate thermogenesis through inhibition of
the catechol-O-methyltransferase enzyme involved in
degradation of norepinephrine [43,57,73,78,79].
Natural hydroxycitric acid (HCA), prepared from
Garcinia cambosia, is a potential natural appetite sup-
Copyright © 2012 SciRes. AJPS

Review Article: Herbal Approach for Obesity Management
Copyright © 2012 SciRes. AJPS
1009
pressant. HCA is a competitive inhibitor of adenosine 5-
triphosphate-citrate lyase, leading to a deceased acetyl
coenzyme A production and decreased fatty acid synthe-
sis. HCA is also thought to suppress feed intake via loss
of apetite by stimulation of liver gluconeogenesis. HCA
is also reported to act by increasing the availability of
5-hydroxytryptamine or serotonin, serotonin is a neuro-
transmitter implicated in regulating eating behavior and
appetite control [24]. Central metabolism of glucose also
suppresses food intake, mediated by the hypothalamic
Table 2. Herbal products for weight management with human studies.
Author Name of
the herbal
product Formulation information Study/Method Subjects Dose/Duration Result
Singh et al.,
[82] Ayurslim
Garcinia cambogia,
Balsamodendron mukul,
Gymnema sylvestre,
Terminalia chebula,
Trigonella foenum-graecum
Phase IV clinical
trial 42 obese patients
of either sex 2 capsules, twice
daily for 6 months
Significant effect in
reducing body weight
and lipid levels
Godard et al.,
[83] Forslean from Coleus
f
orskohlii root
Randomized,
double-blind,
placebo-controlled
study
30 men who were
overweight/obese
250 mg of extract
twice a day for a
12-week period
Causes positive changes
in body composition in
overweight and obese
adult men
Lieberman,
[84]
2
s50-mg capsule of a
tandardized extract of Coleus
f
orskohlii [forskolin (25 mg)] Open blind study 6 overweight,
but otherwise
healthy, women
1 capsule in the
morning and 1 in
the evening, 30
minutes before a
meal. For 4 - 8 weeks
Mean values for body
weight and fat content were
significantly decreased
Henderson et
al., [85]
Forslean
250 mg of ForsLean,
supplying 25 mg of forskolin
Double blinded
placebo controlled
randomized study
60 obese male and
female volunteers 1 capsule twice
daily for 12 weeks Total body weight
significantly decreased
Brown, [86] Lipotrim Chromium 100 mcg,
Garcinia cambogia fruit
extract 50 mg. NA
72 patients of
which 58 (80.5%)
completed the diet
and 39 attended
follow-up.
NA
Sixteen of the 39 patients
had a similar weight from
when they started, three had
gained more than 6 kg,
seven had lost 6 to 12 kg,
and 13 had lost more than
12 kg.
Udani et al.,
[87] Phase 2 Water-extract of a common
white bean (Phaseolus
vulgaris)
Randomized,
double-blind,
placebo-controlled
study
Adults of 35
females, 4 males
1500 mg Phase 2
twice daily with
meals for 8 weeks
Treated group lost an
average of 3.79 lbs (average
of 0.47 lb per week)
compared with the placebo
group, which lost an average
of 1.65 lbs (average of 0.21
lb per week). Triglyceride
levels in the Phase 2 group
were reduced an average of
26.3 mg/dL, more than three
times greater a reduction in
the placebo group
Ignjatovic,
[88] Slimax
Aqueous extract of Hordeum
vulgare, Polygonatum
multiflorum, Dimocarpus
longan , Ligusticum sinense,
Lilium brownii and Zingiber
officinale.
Double-blind
experimental
method Human Subjects Six week period
Significant decrease in
parameters such as body
weight, waist and hip
circumference, and Body
Mass Index (BMI), in all
subjects tested.
Toromanyan
et al., [89] Slim339
Proprietary blend of Garcinia
cambogia extract with calcium
pantothenate (standardized for
the content of hydroxycitric
acid and pantothenic acid) and
extracts of Matricaria
chamomilla, Rosa damascena,
Lavandula officinalis and
Cananga odorata,
Double-blind,
randomized,
parallel-group,
placebo-controlled
study
30 subjects
1 tablet of Slim339
three times per
day (60 - 90 min
before a meal),
for 60 days
Daily oral
self-administration of
Slim339 in the community
reduced body weight in
overweight and obese
healthy human subjects

Review Article: Herbal Approach for Obesity Management
1010
AMPK/malonyl-CoA signaling system [80]. Central ad-
ministration of glucose increases hypothalamic malo-
nyl-CoA, decreases orexigenic neuropeptide expression,
and suppresses food intake. Centrally-administered fruc-
tose provokes feeding, via the AMPK/malonyl-CoA sig-
naling pathway. Thus, decoctions prepared from natural
sources containing excessively high fructose levels may
suppress the hypothalamic malonyl-CoA signaling path-
way, thereby exerting an orexigenic effect [80,81].
6. The Probable Reasons for Obese Person
to Prefer Herbal Products for Weight
Management
1) Health benefits of weight loss without any side ef-
fects.
2) Less demanding than accepted lifestyle changes,
such as exercise and diet.
3) Easily available without a prescription.
4) More easily accepted than a professional consulta-
tion with a physician or a nutritionist.
5) 100% natural origin and perception that natural
means safe.
7. Remarks on Available Information about
Herbal Treatment for Obesity
For many of the herbal weight loss products, there is lit-
tle published information and there have been no clinical
trials or the level of evidence is limited. Some of the
herbal products fall under an acceptable level of evidence
viz., clinical trials and with no scientific background or
scientific rational.
Table 2 compiles available clinical trial literature on
various herbal products which have weight reducing ef-
fects. Few of the products, which underwent clinical trial,
have significant weight reduction as an overall result.
The other products have shown comparatively good re-
sults in pre clinical studies but lack clinical studies.
There are several products in the market claimed to have
remarkable weight reducing effects, however there is no
supporting published pre clinical and clinical data evi-
dences.
8. An Ideal Herbal Remedy for Obesity: A
Proposal
Herbal products for weight reduction may be effective in
the management of obesity and associated disorders.
Consistent and safe herbal product for weight reduction
is a need of developed and developing countries. In our
literature survey, herbal products showed potential ef-
fects on weight control. However, for the majority of
products, more data are needed to assess the suitability as
an anti obesity product. We have attempted to provide
salient futures for an ideal herbal product for the man-
agement of obesity.
1) Should bring down the body weight by 10% over
placebo in a well designed randomized placebo con-
trolled clinical trial.
2) Should show evidence of improvement of bio mark-
ers like blood pressure, lipids and glycemia.
3) Should have known mechanism of action.
4) Should be standardized with bioactive phytochemi-
cals which is/are responsible for anti obesity activity.
5) Should not have any kind of side effects.
9. Conclusion
There are several plants described in ayurveda for weight
management. But so far, no systematic and well designed
screening is attempted to come up with an effective
herbal weight loss product. A better understanding in the
existing evidence based science on herbs will further
guide a qualitative research in obesity management that
will attract the end users by the effective benefits. True
randomized, double blinded, placebo-controlled clinical
trials using herbal products will demonstrate their poten-
tial benefits. Significant weight loss after placebo sub-
traction along with known mechanism of action are re-
quired in order to generate conviction amongst users as
effective agent for weight management.
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