An ethnobotanical study of Indonesian medicinal plants to treat obesity

1. INTRODUCTION

The World Health Organization (WHO) affirms that overweight and obesity are complex disorders characterized by an excessive buildup of body fat that can harm human health [1]. Body mass index (BMI), waist circumference, and body fat percentage are typical metrics for assessing and monitoring obesity levels [2,3]. Adults worldwide are considered obese if their BMI is higher than 30 kg/m²; however, people of Asian descent are considered overweight if it is less than 23 kg/m² and obese if it is greater than 27 kg/m² [4,5]. The WHO classified obesity as a disease in 1998 [1]. It estimated globally that 40% of women and 39% of males over 18 years were overweight in 2016 since the prevalence of obesity in the United States increased from 30.5% to 41.9% between 1999 and March 2020, while the proportion of severely obese people rose from 4.7% to 9.2% [1,6]. Obesity among adults in middle-rural areas tends to be higher than in urban and rural areas. Obesity tends to be higher in middle-class areas with low incomes [2,7,8].

The Indonesian Basic Health Research called Riset Kesehatan Dasar (RISKESDAS) is a comprehensive survey that covers various aspects of health, including health status, causes of death, morbidity, disability, nutritional status, environmental health, household consumption, knowledge and attitudes, and health behaviors [9]. According to the RISKESDAS data, obese cases in Indonesia continues to rise, with the BMI category for adults above 18 years in Indonesia having an obesity percentage value of 21.8% compared to 14.8% in 2013 and 10.5% in 2007 [10–12].

Increased body fat in obesity leads to dysfunctional of adipose tissue and aberrant fat, which improves physical performance but has detrimental implications for one’s metabolism, biomechanics, and mental health [13–15]. Additionally, obesity enables to generate several chronic diseases, such as diabetes, cancer, heart disease, liver disease, renal issues, and nerve degeneration [16–18].

Several countries have been practicing on using medicinal plants for treating obesity, including China, Japan, Thailand, and the Himalayan countries [19,20]. Widely, the indigenous and local knowledge of medicinal plants has long been a source of research to examine plant potential effects and develop therapeutic resources [21]. Research on Medicinal Plants and Traditional Medicine or Riset Tumbuhan Obat dan Jamu (RISTOJA) was an explorative research that documented the traditional use of medicinal plants and traditional medicine based on ethnics in Indonesia. Numerous plants have been explored for their potential utilization to support weight management and improve overall health status [22,23]. Although individuals have used medicinal plants to maintain weight for generations, their safety and medicinal effectiveness are still becoming a concern [24]. Indonesia’s archipelago geography can help the vast diversity of local knowledge and wisdom in conquering obesity [25]. This study will inventory and evaluate herbal remedies derived from Indonesian medicinal plants, which are extensively acknowledged and employed by various ethnic groups for obesity treatment, thereby highlighting a substantial traditional knowledge base to assist individuals in weight loss. This information would be advantageous to society in exploring more utilization of Indonesian plants that have been used to maintain an ideal body weight.

2. MATERIALS AND METHODS

RISTOJA was held by the National Institute of Health Research and Development (NIHRD), which performed in ethnic groups throughout Indonesia, with a total of 405 ethnicities. The ethnic groups involved in the study were determined using some criteria. The ethnic group should have at least 1000 native members and reside in a definite area for generations, among them at least five practitioners as traditional healers using plants for treating their communal diseases. The data on plant ingredients for reducing excess body weight resulted from RISTOJA results in 2012, 2015, and 2017 and was authenticated until 2019 officially obtained from the Data Management Laboratory. The plant data used were plants that have been identified to the species level. The data analysis step includes data analysis in the form of the number of ingredients, the number of plant species, and the plant parts used. A total of 405 ethnicities were interviewed about herbs to treat several diseases, including obesity. However, after further screening, only 30 ethnicities had anti-obesity herbs. All these ethnicities are spread across different regions so they are only found in certain areas.

3. RESULT AND DISCUSSION

Out of the 405 ethnic groups observed, respondents (traditional healers) who used medicinal plants to manage obesity were only from 30 different ethnic backgrounds. Interestingly, while comprising less than 30% of the entire ethnic group, they are quite evenly spread throughout almost all of Indonesia’s islands, i.e., on the islands of Java, Kalimantan, Sulawesi, and Papua (Fig. 1).

Figure 1. Distribution ethnic groups in Indonesia who use plants for overweight. 1: Pakpak; 2: Abung Seputih; 3: Banten; 4: Betawi; 5: Sunda Priangan; 6: Cirebon; 7: Jawa; 8: Madura; 9: Bawean; 10: Kanayan Mempawah; 11: Tobak; 12: Dayak Tabuyan; 13: Dayak Apokayan; 14: Putuk; 15: Lepo Tau; 16: Bulongan; 17: Kore; 18: Krowe Muhang; 19: Kole Susu; 20: To Badaya; 21: Tialo; 22: Mian Sea Sea; 23: Ratahan; 24: Buru; 25: Fordata; 26: Kao Dalam; 27: Wandamen; 28: Damal; 29: Yakai; 30: Demta. [Click here to view]

Ethnic groups with anti-obesity ingredients were spread across almost all major islands in Indonesia. However, only 18 of the 38 provinces, representing 30 ethnicities, employ medicinal herbs to manage obesity. The provinces with the highest ethnicities using anti-obesity concoctions were East Java, North Kalimantan, Papua, and Central Sulawesi, each with three ethnicities (Fig. 1). The ethnicity distribution, which has plant-derived potions for obesity, might have an association with the prevalence of overweight. Indonesia’s Nutritional Status Survey (SSGI) held in 2022 revealed that the prevalence of toddlers’ overweight in Papua, Central Kalimantan, East Kalimantan, West Kalimantan, and Banten was 6.7%, 5.6%, 4.0%, 3.9%, and 3.9%, respectively. West Java and East Java are at 3.6%, exceeding the national average of 3.5% [34]. Trends in the prevalence of overweight among toddlers in Indonesia have also increased in almost all provinces [35]. During the years 1993 to 2014, there was an increase of around 10% in overweight among adolescents aged 6–12 years and around 7% in overweight adults aged 13–18 years [36]. These ethnicities are spread across almost all the large islands in Indonesia. Madura and Java use a wider variety of plants to overcome these problems. The use of plant ingredients for treatment among the Java has been passed down from generation to generation, known as Jamu and recorded since the 5th century. Jamu means prayer or medicine to improve health [37].

Traditional healers who had anti-obesity remedies were 12% more women than males (Fig. 2A), which related to the gender perception of obesity. Women were more worried with the weight and body shape issue than males [38,39]. Furthermore, patients prefer to see medical practitioner of their same gender. This is especially relevant for women, particularly when discussing gender-related health issues, such as reproductive organ health, body shape, and body weight. This may explain why female traditional healers are more likely to have a weight loss concoction. Most of the traditional healers who have anti-obesity herbs were 40–50 years old. There were 26.67% of traditional healers whose anti-obesity ingredients were more than 70 years old because to become a traditional healer, someone must have specific requirements that not everyone was able to fulfill [40]. More than 30% of traditional healers who have anti-obesity herbs did not have adequate education (Fig. 2C). People with low education do not receive much socialization or information regarding medical treatment, and their low level of education causes people to tend to use traditional medicine as an alternative treatment [41].

Figure 2. The characteristics of traditional healers. A: Gender of traditional healer; B: Age of traditional healer; C: Education level of traditional healer. [Click here to view]

Table 1 shows that 73 plant species belonging to 32 families are used for tackling obesity. Zingiberaceae was the most widely used family to treat overweight comprising 10 plant species, including Boesenbergia rotunda, Curcuma aeruginosa, Curcuma heyneana, Curcuma longa, Curcuma zanthorrhiza, Kalmia angustifolia, Kaempferia galanga, Zingiber. officinale, and Zingiber zerumbet. Three plant species from the Zingiberaceae family with the highest RUV and UF values are C. zanthorrhiza, Z. officinale, and Z. zerumbet. Compounds of Z. officinale are reported to be capable of activating transient receptor potential vanilloid type 1 and boosting adrenaline production. Gingerol and shogaol are compounds found in Z. officinale, which are capable of increasing thermogenesis. Gingerol prevents adipocyte differentiation, preventing preadipocyte cells from developing into mature adipocytes. Other mechanisms include peroxisome proliferator-activated receptor delta, a basic regulator of energy metabolism in skeletal and adipose tissue 6-shogaol, and stimulation of lipid oxidation [42]. Curcuma zanthorrhiza consists mainly of xanthorrhizol, curcuminoids, and essential oils [43,44]. The primary active constituent of xanthorrhizol can inhibit adipogenesis in the formation of adipocytes [45]. Javanese turmeric (C. zanthorrhiza) essential oil lowered LDL cholesterol and body weight in rats; thus, C. zanthorrhiza affects lipid metabolism [46], which might be through inhibition of lipogenesis or enhancement of lipolysis [47]. Zingiber zerumbet has been studied and may indirectly improve metabolic health [48], and there is some evidence that some studies have reported that zerumbone is an important factor in weight management by inhibiting adipogenesis, the development of fat cells in 3T3-L1 cells [49]. The Z. zerumbet rhizome ethanol extract on improving testosterone levels and spermatogenesis and its possible role in obese induced reproductive dysfunction in high-fat-diet-induced obese rats has also been found [50].

Table 1. Plant parts used, local names, plant parts used, RFC, UV, and FUV of various medicinal plant used to overcome obesity in Indonesia.

Based on Table 1, various parts of plants used in preventing obesity include rhizomes, tubers, bark, flowers, leaves, fruit, stems, seeds, roots, and herbs. The most widely used are leaves (25 species), fruit (13 species), bark (12 species), and rhizomes (11 species). The primary part of plants frequently used was leaves, considerably due to the availability of those parts for a whole year, especially in tropical regions, which makes them easier to obtain in sufficient amounts than other parts. Besides, they are easily regenerated, and harvesting leaves is considered to have less destructive effects and a minor negative impact on further plant growth and survival. They also contain many active compounds which have medicinal properties [51]. The most common plant part used by Zingiberaceae is the rhizome. This plant part is widely used as a pharmaceutical raw material because it contains various bioactive compounds such as polyphenols or volatiles [52].

The relative frequency of citation (RFC) is a widely employed method for calculating percentages in anthropology and the social sciences. Its intuitive and fundamental nature has made it a prevalent tool that does not necessitate conversion into a distinct index. A UV indicates how effectively certain plant species treat a particular condition locally [53,54]. The RFC and UV values of various medicinal plants used to overcome obesity in Indonesia were between 0.023 and 0.68 (Table 2). RFC and UV have a standard deviation that is smaller than the mean, indicating low variation between the maximum and minimum values. The highest RFV was obtained in Gymnanthemum amygdalinum, Euphorbia heterophylla, and Z. zerumbet. The RFC value showed that the informants mostly used these three species to treat obesity. Meanwhile, the highest UV was found in G. amygdalinum, E. heterophylla, T. indica, Q. infectoria, C. zanthorrhiza, and Z. zerumbet. The families with high FUV (family use value) were Fagaceae (FUV = 0.068), Acoraceae, Amaryllidaceae, Lauraceae, and Solanaceae (FUV = 0.045), as shown in Table 1. The FUV can be employed to ascertain the relative significance of plant families in terms of their utility, surpassing random estimations. This metric is present to underscore the families that denote a greater range of uses [55]. The main objectives of medicinal plants and their derived products are to hinder the activity of pancreatic lipase, reduce appetite, enhance thermogenesis and lipid metabolism, limit the breakdown of fats, and encourage the formation of fat cells [56]. With a p-value of less than 1% and a Pearson correlation coefficient of 0.7947 between RFC and UV, there is clear evidence of a strong positive significant relationship between the relative importance of plant use and the local significance of each species (Table 2). There are generally more usable therapeutic herbs when the informants’ species are used more frequently [31]. Variation in species used in obesity: 63% of the variation in RFC can be explained by that of UV.

Table 2. Pearson for relative frequency citation (RFC) and use value (UV) of various medicinal plant used to overcome obesity in Indonesia.

Traditional medicine in Indonesia is a method of therapy employing traditional procedures that have been passed down from generation to generation in accordance with community customs. It is the accumulation of knowledge, skills, and practices based on the theories, beliefs, and experiences of people with various cultural customs. These aspects underlie the basis of the variances between ethnic groups. The similarity analysis showed that most of the 30 ethnic groups had different knowledge of the ingredients for overcoming obesity (100% dissimilarity). Two ethnic clusters had 100% similarity in medicinal plants usage knowledge to overcome overweight: the Ratahan (no. 23) and Wandamen (no. 27) cluster and the Dayak Tabuyan (no. 12) and Kanayan Mempawah (no. 10) cluster (Fig. 3). The Ratahan and Wandamen ethnic groups only use the Leucaena leucocephala plant in medicine, while the Dayak Tabuyan and Kanayan Mempawah ethnic groups only use Croton tiglium. The L. leucocephala and C. tiglium are known to have a wide distribution, likewise in Indonesia [57–59], so it is easy to find even for ethnic groups that are ubiquitous. The representation of similarity between samples in the dendrogram of Bray−Curtis similarity index-based clustering in Figure 4 can be excellent. This is indicated by the coefficient of phylogenetic similarity, which is 0.96. The coefficient of coefficients has a function to measure the distance in the classification of data sets and the efficiency of clustering techniques, with a value of 0–1. A value closer to 1 indicates that the clustering and distance are more accurate [60]. People also widely use herbs and spices that contain therapeutic ingredients that are beneficial to their diet [61]. Previous research states that ethnicity, dietary habits, and geographical origin are closely interrelated, and are key factors in determining the diversity of the gut microbiome. Knowledge of benefits, cultivation techniques, and creativity in handling, processing, and cooking is needed to empower communities to utilize local biodiversity [62]. The use of medicinal plants for a particular problem carried out in a large area shows a low level of similarity, because traditional healers have local wisdom that is specific to their respective regions by utilizing the natural resources around them [25].

Figure 3. UPGMA bray curtis similarity index of ethnic clustering based on the utilization of medicinal plants to overcome overweight with the. 1: Pakpak; 2: Abung Seputih; 3: Banten; 4: Betawi; 5: Sunda Priangan; 6: Cirebon; 7: Jawa; 8: Madura; 9: Bawean; 10: Kanayan Mempawah; 11: Tobak; 12: Dayak Tabuyan; 13: Dayak Apokayan; 14: Putuk; 15: Lepo Tau; 16: Bulongan; 17: Kore; 18: Krowe Muhang; 19: Kole Susu; 20: To Badaya; 21: Tialo; 22: Mian Sea Sea; 23: Ratahan; 24: Buru; 25: Fordata; 26: Kao Dalam; 27: Wandamen; 28: Damal; 29: Yakai; 30: Demta. [Click here to view]

Most ethnicities shared similarities in the types and applications of medicinal plants used to treat obesity (93.15% of medicinal plants were alike). Ethnic Mian Sea-sea (no. 22)-To Badaya (no. 20)-Fordata (no. 25) differed from other ethnicities because they had a variety of medicinal plants for obesity, which were substantially distinct from other ethnicities; those three ethnicities were located at different coordinates from practically every other ethnicity (Fig. 4). Plants such as E. heterophylla L. (Fig. 5A) were only used by the Mian Sea-sea, To Badaya, and Fordata ethnicities. Pleurolobus gangeticus (L.) DC. (Fig. 5B) and Pongamia pinnata (L.) Pierre (Fig. 5D) were used only by the Mian Sea-sea ethnicity, as well as Hyptis capitata Jacq. (Fig. 5C), and Psidium guajava L. (Fig. 5E) was used only by the To Badaya ethnic (Table 1).

Figure 4. Scatterplot NMDS ordination in bray-curtis similarity index between ethnic groups based on medicinal plants knowledge to overcome obesity. 1: Pakpak; 2: Abung Seputih; 3: Banten; 4: Betawi; 5: Sunda Priangan; 6: Cirebon; 7: Jawa; 8: Madura; 9: Bawean; 10: Kanayan Mempawah; 11: Tobak; 12: Dayak Tabuyan; 13: Dayak Apokayan; 14: Putuk; 15: Lepo Tau; 16: Bulongan; 17: Kore; 18: Krowe Muhang; 19: Kole Susu; 20: To Badaya; 21: Tialo; 22: Mian Sea Sea; 23: Ratahan; 24: Buru; 25: Fordata; 26: Kao Dalam; 27: Wandamen; 28: Damal; 29: Yakai; 30: Demta. [Click here to view]

Figure 5. Some of medicinal plants used as anti-obesity. A: Euphorbia heterophylla L.; B: Pleurolobus gangeticus (L.) J.St.-Hil. Ex H. Ohashi & K. Ohashi; C: Hyptis capitata Jacq.; D: Pongamia pinnata (L.) Pierre; E: Psidium guajava L. [Click here to view]

Previous research stated that one species of medicinal plant could be used to cure more than one disease, whereas one disease could be treated by using more than one medicinal plant. The part widely used as an ingredient in the present study was the leaves. Local people select medicinal plants based on their understanding of efficacy [63]. Besides, previous research has stated that medicinal plants used as raw materials for drugs are relatively safe to use, have no side effects, are easily absorbed and digested by the body, and are not toxic [64]. In addition, there are similarities in the therapeutic activity of several medicinal plants from one region to another region. In Indonesia, the wealth of medical knowledge for overweight people is very diverse. Given that different cultures have diverse knowledge, we found similarities in the choice of plants and patterns of use of these plants in several ethnic groups. In addition, it was discovered that these ethnicities had different strategies [65]. The usage of wild plants for a variety of purposes, particularly medicinal plants for the treatment of excess weight, can lead to extinction if not balanced with significant awareness and strong commitment to conserving local resources. The primary causes of the decline of knowledge included the interruption of oral-based information transfer, the extinction of medicinal plant species owing to over-harvesting, other detrimental human factors, and contemporary drug system [66].

The level of vegetation and plants typically found around these ethnic groups, as well as the similarity ecology, influence the similarity of plant types used as traditional medicine to treat obesity at the tribal level in Indonesia. The ethnobiological similarities found, based on local knowledge regarding the use of medicinal plants to treat obesity, can be used as a utilitarian tool/index for future research, especially for assessing the quantitative ethnobiological data studied [67]. Studies related to the diversity of ethnobotanical knowledge in each ethnicity can be used to increase awareness about conserving natural resources regarding medicinal plants [68]. More study is needed concerning the chemical composition and biological activity of plants frequently utilized by various ethnic groups [69]. The fact is that many traditional healers still harvest plants from nature’s habitat without cultivating them, so thus conservation measures are urgently needed to prevent the extinction of these medicinal plants [70].

4. CONCLUSION

This study showed that there were many medicinal plants to treat obesity. It has been documented that 30 ethnic groups from 19 provinces in Indonesia use medicinal plants to treat obesity. Species from the Zingiberaceae family are most widely used to treat obesity. G. amygdalinum, E. heterophylla, and Z. zerumbet were identified as the species most commonly used by traditional healers. The most widely used plant family was Fagaceae, with a percentage of 6.8%. There was a strong positive significant relationship between the relative importance of plant use and the local significance of each anti-obesity plant species used by ethnicities in Indonesia. Most ethnicities that use plants to treat obesity have different knowledge about herbs to treat excess weight (100% dissimilarity). The typical level of vegetation and plants found around the tribe, as well as ecological similarities, influence the similarity of plant types used as traditional medicine to treat obesity at the tribal level in Indonesia. Studies related to the diversity of ethnobotanical knowledge in each ethnic group can be used to increase awareness of conserving natural resources related to medicinal plants. The most widely used traditional medicinal plants, such as G. amygdalinum, E. heterophylla, and Z. zerumbet, can be researched and developed to be utilized by the wider community as anti-obesity.

5. ACKNOWLEDGMENT

The research was funded by DIPA of the Center for Research and Development of Medicinal and Traditional Medicinal Plants, the NIHRD National Institute Health Research and Development, Ministry of Health of the Republic of Indonesia (MoH R.I.) involving stakeholders from the central government to the regions and various parties. Universities from all over Indonesia were involved in RISTOJA. The data usage has been approved by the NIHRD MoH R.I. with letter number 30011803-025.

6. AUTHORS CONTRIBUTION

All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; agreed to submit to the current journal; gave final approval of the version to be published; and agree to be accountable for all aspects of the work. All the authors are eligible to be an author as per the International Committee of Medical Journal Editors (ICMJE) requirements/guidelines.

7. CONFLICTS OF INTEREST

The authors report no financial or any other conflicts of interest in this work.

8. ETHICAL APPROVAL

The ethical approval was obtained from the Chair of the Health Research Ethics Committee, Health Research and Development Agency, Ministry of Health, Republic of Indonesia, with approval numbers LB.02.01/5.2/KE.318/2015 and LB.02.01/2.Ke.107/2017.

9. DATA AVAILABILITY

All data collected and analyzed are incorporated in this study article.

10. PUBLISHER’S NOTE

The authors solely make the claims in this article; they do not necessarily represent the publisher, editors, or reviewers. This journal maintains a neutral stance regarding jurisdictional claims in published institutional affiliations.

11. USE OF ARTIFICIAL INTELLIGENCE (AI)-ASSISTED TECHNOLOGY

The authors declare that they did not utilize artificial intelligence (AI) techniques for authoring and editing the work, and no pictures were modified using AI.

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