The Role of Plant-Based Dietary Patterns in Obesity Risk among Young Adults

Himmatunnisak Mahmudah; Ardy Wicaksono; Vivit Vidiasari; Yunita; Rani Rahmasari Tanuwijaya

Authors

Himmatunnisak Mahmudah Universitas Sugeng Hartono, Indonesia
Ardy Wicaksono Universitas Sugeng Hartono, Indonesia
Vivit Vidiasari Akbid Harapan Mulya Ponorogo, Indonesia
Yunita Poltekkes Kemenkes Bengkulu, Indonesia
Rani Rahmasari Tanuwijaya Sekolah Tinggi Ilmu Kesehatan Pertamedika, Indonesia

Keywords:

plant-based diet, healthy plant-based diet index, obesity, young adults, Indonesia, dietary patterns

Abstract

Obesity increasingly begins in young adulthood, a life stage in which dietary habits formed during the transition to independent living tend to persist and shape long-term cardiometabolic risk. Plant-based dietary patterns are widely promoted as a strategy for weight control, yet their effects depend strongly on the quality of the plant foods consumed. This article reviews the published literature on plant-based dietary patterns and obesity risk in young adults and interprets that literature against publicly available data from the World Health Organization, the Global Burden of Disease study, and the Indonesian national health surveys Riskesdas 2018 and Survei Kesehatan Indonesia 2023. The review defines plant-based patterns as a spectrum ranging from flexitarian eating to veganism and distinguishes healthful plant-based indices, built on whole grains, vegetables, fruits, legumes, and nuts, from unhealthful indices dominated by refined grains, sugar-sweetened beverages, and sweets. The synthesised evidence shows that healthful plant-based patterns are consistently associated with lower body mass index, slower weight gain, and lower risks of obesity related outcomes including type 2 diabetes and coronary heart disease, whereas unhealthful plant-based patterns show neutral or adverse associations. Plausible mechanisms include lower dietary energy density, higher fibre intake and satiety, and rapid diet induced shifts in the gut microbiota. The Indonesian context adds urgency, because adult obesity prevalence rose from 21.8 percent in 2018 to 23.4 percent in 2023 while ultra-processed foods and sedentary campus and office routines spread among young adults. The novelty of this review lies in joining the healthy versus unhealthy plant food distinction to the specific behavioural and food environment conditions of Indonesian young adults, and in deriving practical guidance that promotes plant rich eating without ignoring vitamin B12, protein adequacy, and disordered eating risks.

References

[1] World Health Organization, "Obesity and overweight," Fact sheet, Geneva, Switzerland: WHO, 2024. [Online]. Available: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
[2] NCD Risk Factor Collaboration, "Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults," The Lancet, vol. 403, no. 10431, pp. 1027-1050, 2024, doi: 10.1016/S0140-6736(23)02750-2.
[3] Kementerian Kesehatan Republik Indonesia, Laporan Nasional Riskesdas 2018. Jakarta, Indonesia: Badan Penelitian dan Pengembangan Kesehatan, Kemenkes RI, 2019.
[4] Kementerian Kesehatan Republik Indonesia, Survei Kesehatan Indonesia (SKI) Tahun 2023. Jakarta, Indonesia: Badan Kebijakan Pembangunan Kesehatan, Kemenkes RI, 2024.
[5] GBD 2017 Diet Collaborators, "Health effects of dietary risks in 195 countries, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017," The Lancet, vol. 393, no. 10184, pp. 1958-1972, 2019, doi: 10.1016/S0140-6736(19)30041-8.
[6] M. Blüher, "Obesity: global epidemiology and pathogenesis," Nature Reviews Endocrinology, vol. 15, no. 5, pp. 288-298, 2019, doi: 10.1038/s41574-019-0176-8.
[7] Y. C. Chooi, C. Ding, and F. Magkos, "The epidemiology of obesity," Metabolism, vol. 92, pp. 6-10, 2019, doi: 10.1016/j.metabol.2018.09.005.
[8] B. M. Popkin and P. Gordon-Larsen, "The nutrition transition: worldwide obesity dynamics and their determinants," International Journal of Obesity, vol. 28, suppl. 3, pp. S2-S9, 2004, doi: 10.1038/sj.ijo.0802804.
[9] C. A. Monteiro, G. Cannon, R. B. Levy, J.-C. Moubarac, M. L. C. Louzada, F. Rauber, N. Khandpur, G. Cediel, D. Neri, E. Martinez-Steele, L. G. Baraldi, and P. C. Jaime, "Ultra-processed foods: what they are and how to identify them," Public Health Nutrition, vol. 22, no. 5, pp. 936-941, 2019, doi: 10.1017/S1368980018003762.
[10] K. D. Hall et al., "Ultra-processed diets cause excess calorie intake and weight gain: an inpatient randomized controlled trial of ad libitum food intake," Cell Metabolism, vol. 30, no. 1, pp. 67-77.e3, 2019, doi: 10.1016/j.cmet.2019.05.008.
[11] M. C. Nelson, M. Story, N. I. Larson, D. Neumark-Sztainer, and L. A. Lytle, "Emerging adulthood and college-aged youth: an overlooked age for weight-related behavior change," Obesity, vol. 16, no. 10, pp. 2205-2211, 2008, doi: 10.1038/oby.2008.365.
[12] W. Willett et al., "Food in the Anthropocene: the EAT-Lancet Commission on healthy diets from sustainable food systems," The Lancet, vol. 393, no. 10170, pp. 447-492, 2019, doi: 10.1016/S0140-6736(18)31788-4.
[13] A. Satija and F. B. Hu, "Plant-based diets and cardiovascular health," Trends in Cardiovascular Medicine, vol. 28, no. 7, pp. 437-441, 2018, doi: 10.1016/j.tcm.2018.02.004.
[14] V. Melina, W. Craig, and S. Levin, "Position of the Academy of Nutrition and Dietetics: vegetarian diets," Journal of the Academy of Nutrition and Dietetics, vol. 116, no. 12, pp. 1970-1980, 2016, doi: 10.1016/j.jand.2016.09.025.
[15] P. N. Appleby and T. J. Key, "The long-term health of vegetarians and vegans," Proceedings of the Nutrition Society, vol. 75, no. 3, pp. 287-293, 2016, doi: 10.1017/S0029665115004334.
[16] A. Satija et al., "Plant-based dietary patterns and incidence of type 2 diabetes in US men and women: results from three prospective cohort studies," PLOS Medicine, vol. 13, no. 6, p. e1002039, 2016, doi: 10.1371/journal.pmed.1002039.
[17] A. Satija et al., "Healthful and unhealthful plant-based diets and the risk of coronary heart disease in US adults," Journal of the American College of Cardiology, vol. 70, no. 4, pp. 411-422, 2017, doi: 10.1016/j.jacc.2017.05.047.
[18] E. C. Hemler and F. B. Hu, "Plant-based diets for personal, population, and planetary health," Advances in Nutrition, vol. 10, suppl. 4, pp. S275-S283, 2019, doi: 10.1093/advances/nmy117.
[19] U. Fresán and J. Sabaté, "Vegetarian diets: planetary health and its alignment with human health," Advances in Nutrition, vol. 10, suppl. 4, pp. S380-S388, 2019, doi: 10.1093/advances/nmz019.
[20] B. J. Rolls, "The relationship between dietary energy density and energy intake," Physiology & Behavior, vol. 97, no. 5, pp. 609-615, 2009, doi: 10.1016/j.physbeh.2009.03.011.
[21] N. C. Howarth, E. Saltzman, and S. B. Roberts, "Dietary fiber and weight regulation," Nutrition Reviews, vol. 59, no. 5, pp. 129-139, 2001, doi: 10.1111/j.1753-4887.2001.tb07001.x.
[22] A. Reynolds et al., "Carbohydrate quality and human health: a series of systematic reviews and meta-analyses," The Lancet, vol. 393, no. 10170, pp. 434-445, 2019, doi: 10.1016/S0140-6736(18)31809-9.
[23] L. A. David et al., "Diet rapidly and reproducibly alters the human gut microbiome," Nature, vol. 505, no. 7484, pp. 559-563, 2014, doi: 10.1038/nature12820.
[24] A. Satija, V. Malik, E. B. Rimm, F. Sacks, W. Willett, and F. B. Hu, "Changes in intake of plant-based diets and weight change: results from 3 prospective cohort studies," The American Journal of Clinical Nutrition, vol. 110, no. 3, pp. 574-582, 2019, doi: 10.1093/ajcn/nqz049.
[25] F. Qian, M. C. Liu, F. B. Hu, and S. N. Bhupathiraju, "Association between plant-based dietary patterns and risk of type 2 diabetes: a systematic review and meta-analysis," JAMA Internal Medicine, vol. 179, no. 10, pp. 1335-1344, 2019, doi: 10.1001/jamainternmed.2019.2195.
[26] S. Tonstad, T. Butler, R. Yan, and G. E. Fraser, "Type of vegetarian diet, body weight, and prevalence of type 2 diabetes," Diabetes Care, vol. 32, no. 5, pp. 791-796, 2009, doi: 10.2337/dc08-1886.
[27] M. Rosell, P. Appleby, E. Spencer, and T. Key, "Weight gain over 5 years in 21,966 meat-eating, fish-eating, vegetarian, and vegan men and women in EPIC-Oxford," International Journal of Obesity, vol. 30, no. 9, pp. 1389-1396, 2006, doi: 10.1038/sj.ijo.0803305.
[28] M. Dinu, R. Abbate, G. F. Gensini, A. Casini, and F. Sofi, "Vegetarian, vegan diets and multiple health outcomes: a systematic review with meta-analysis of observational studies," Critical Reviews in Food Science and Nutrition, vol. 57, no. 17, pp. 3640-3649, 2017, doi: 10.1080/10408398.2016.1138447.
[29] R.-Y. Huang, C.-C. Huang, F. B. Hu, and J. E. Chavarro, "Vegetarian diets and weight reduction: a meta-analysis of randomized controlled trials," Journal of General Internal Medicine, vol. 31, no. 1, pp. 109-116, 2016, doi: 10.1007/s11606-015-3390-7.
[30] G. M. Turner-McGrievy, C. R. Davidson, E. E. Wingard, S. Wilcox, and E. A. Frongillo, "Comparative effectiveness of plant-based diets for weight loss: a randomized trial of five different diets," Nutrition, vol. 31, no. 2, pp. 350-358, 2015, doi: 10.1016/j.nut.2014.09.002.
[31] H. Kahleova et al., "The effect of a vegetarian vs conventional hypocaloric diabetic diet on thigh adipose tissue distribution in subjects with type 2 diabetes: a randomized study," Journal of the American College of Nutrition, vol. 36, no. 6, 2017, doi: 10.1080/07315724.2017.1302367.
[32] N. D. Barnard et al., "A low-fat vegan diet and a conventional diabetes diet in the treatment of type 2 diabetes: a randomized, controlled, 74-wk clinical trial," The American Journal of Clinical Nutrition, vol. 89, no. 5, pp. 1588S-1596S, 2009, doi: 10.3945/ajcn.2009.26736H.
[33] R. Pawlak, S. E. Lester, and T. Babatunde, "The prevalence of cobalamin deficiency among vegetarians assessed by serum vitamin B12: a review of literature," European Journal of Clinical Nutrition, vol. 68, no. 5, pp. 541-548, 2014, doi: 10.1038/ejcn.2014.46.
[34] H. Lynch, C. Johnston, and C. Wharton, "Plant-based diets: considerations for environmental impact, protein quality, and exercise performance," Nutrients, vol. 10, no. 12, p. 1841, 2018, doi: 10.3390/nu10121841.
[35] A. M. Bardone-Cone et al., "The inter-relationships between vegetarianism and eating disorders among females," Journal of the Academy of Nutrition and Dietetics, vol. 112, no. 8, pp. 1247-1252, 2012, doi: 10.1016/j.jand.2012.05.007.
[36] H. Kahleova, S. Levin, and N. Barnard, "Cardio-metabolic benefits of plant-based diets," Nutrients, vol. 9, no. 8, p. 848, 2017, doi: 10.3390/nu9080848.