Sleep, lipids, and metabolic health in the Indian obesity epidemic: an integrative review of mechanisms, burden, and breakthroughs

BACKGROUND: India faces a growing obesity epidemic within the context of persistent undernutrition, creating a dual burden with major cardiometabolic consequences. This population is particularly vulnerable to metabolic disease because of the "Asian Indian phenotype," characterized by increased visceral adiposity and higher metabolic risk at lower body mass index thresholds. OBJECTIVE: To review current evidence on the relationship between sleep health, lipid dysregulation, and metabolic dysfunction in the obesity epidemic in India, with emphasis on epidemiology, biologic mechanisms, and implementation relevance. METHODS: PubMed-indexed literature published from 2015 through February 2026 was reviewed, prioritizing India-specific epidemiologic studies, national reports, and policy-relevant publications. International mechanistic studies were included when relevant to biologic plausibility and translational understanding. RESULTS: Obesity in India shows substantial regional and urban-rural variation, while dyslipidemia remains highly prevalent and inadequately controlled, particularly in people with type 2 diabetes mellitus. Sleep disturbances, including short sleep duration, circadian misalignment, shift work, and obstructive sleep apnea, are increasingly recognized as contributors to metabolic dysfunction. Mechanistic evidence suggests that sleep disruption may impair metabolic health through clock gene dysregulation, bile acid-lipid desynchronization, microbiome-derived short-chain fatty acid signaling, inflammation, and neuroendocrine stress pathways. However, India-specific lipidomic, longitudinal, and sleep-focused interventional data remain limited. CONCLUSIONS: Sleep health disturbances appear to be important and potentially modifiable contributors to metabolic dysfunction in India. Improving access to obstructive sleep apnea diagnosis and continuous positive airway pressure therapy, strengthening dyslipidemia management, and integrating sleep health into broader noncommunicable disease frameworks may improve prevention and care in high-risk Indian populations.