Association of Ketogenic Diet Adherence with Body Weight and Adiposity in Overweight and Obese Adults in Islamabad, Pakistan

Abstract

Obesity is a rapidly escalating public health concern in Pakistan, driven by urbanization, sedentary lifestyles, and dietary transitions. The ketogenic diet (KD), a high-fat and very lowcarbohydrate dietary approach has gained global interest for its potential to induce nutritional ketosis, enhance lipolysis and improve metabolic regulation. This study examined the association between self-reported adherence to a ketogenic diet and changes in body weight, lipid profile, fasting insulin and metabolic outcomes among overweight and obese adults in Islamabad, Pakistan.  This cross-sectional analytical study included 300 adults (BMI ≥25 kg/m²), voluntarily adhered to a ketogenic diet for at least four weeks. Self-reported baseline and post-adherence anthropometric and biochemical data were analyzed. Outcomes included body weight, BMI, triglycerides, LDL-C (low density lipoprotein cholesterol) HDL-C (high density lipoprotein cholesterol) and fasting insulin. Sociodemographic and lifestyle factors were evaluated as secondary predictors. Paired t-tests and linear regression analyses were applied to estimate changes linked with ketogenic diet adherence with significant reductions in body weight and BMI (5–8 kg/m²) observed among obese males. In 67.7% of participants, improved Triglyceride levels while fasting insulin decreased in 78.7%, indicating enhanced metabolic efficiency. LDL-C responses were heterogeneous, with 33.0% reporting a decrease, 32.0% no change, and 29.3% an increase. Participants with higher baseline BMI, triglycerides, and fasting insulin experienced greater reductions (p < 0.05). Additionally, 63% reported increased energy levels, 76.3% expressed overall satisfaction, and adverse effects were minimal. In conclusion, ketogenic diet adherence was associated with reduced adiposity and improved metabolic markers in this self-selected cohort.