Obesity

The pandemic of overweight and obesity presents a significant challenge for chronic disease prevention and health across life courses around the world, fueled by economic growth, industrialization, mechanized support, urbanization, an increasingly sedentary lifestyle, and a nutritional transition to processed foods and high-calorie diets over the last 3 decades. The rising prevalence of childhood obesity, in particular, forebodes a staggering burden of disease in individuals and healthcare systems in the decades to come.

Obesity is defined simply as excess body weight for height i.e. BMI > 30 Kg/m².

• Increased energy consumption

1. Intake of a large portions of food
2. Increased snacking and loss of regular meals
3. Sugar-sweetened beverages
4. Processed and unprocessed red meats
5. Increased affluence

• Decreased energy expenditure

1. Physical inactivity and decreased manual labor
2. Sedentary lifestyles
3. Leisure time activities
4. Increased time spent on computer games, watching TV
5. Increased car ownership

• Reversible causes

1. Hypothyroidism
2. Cushing’s syndrome
3. Insulinoma
4. Drug treatments: – Atypical antipsychotics, Sodium valproate, Beta-blockers, Glucocorticoids, insulin, Sulphonylureas, etc.

• Idiopathic causes

1. Genetic factors: –
2. Mutation of melanocortin-4 receptor
3. Mutation leptin gene
4. Prader-Willi syndrome
5. Lawrence-Moon-Biedl syndrome

• Increased energy consumption

1. Intake of large portion of food
2. Increased snacking and loss of regular meals
3. Sugar-sweetened beverages
4. Processed and unprocessed red meats
5. Increased affluence

• Decreased energy expenditure

1. Physical inactivity and decreased manual labor
2. Sedentary lifestyles
3. Leisure time activities
4. Increased time spent on computer games, watching TV
5. Increased car ownership

• Reversible causes

1. Hypothyroidism
2. Cushing’s syndrome
3. Insulinoma
4. Drug treatments: – Atypical antipsychotics, Sodium valproate, Beta-blockers, Glucocorticoids, insulin, Sulphonylureas etc.

• Idiopathic causes

1. Genetic factors: –
2. Mutation of melanocortin-4 receptor
3. Mutation leptin gene
4. Prader-Willi syndrome
5. Lawrence-Moon-Biedl syndrome

Ayurveda has given more emphasis on the balanced state of body tissues & mind while mentioning definition of health. According to Ayurveda, Obesity is a condition in which Medodhathu (Fatty component of body) is in a state of vikrita vriddhi (abnormal increase) and can be corelated with Sthoulya. The hereditary component i.e. Bijadushti, besides dietetic regime and psychological factors in the causation of obesity is described by Ayurveda Samhitas. Except these factors, the components which may vitiate medodhathu, and kapha dosha could be considered as causative factors of sthoulya. Dhathvagni mandya (Weak digestive fire at tissue level) is the root cause for all these in the etipathogenesis of sthoulya.

Causative factors of sthoulya: –

Adhyasana, avyayama, amatvam, divaswapnam, brumhana ahara vihara, avyavaya

Sthoulya Lakshanas mentioned in Ayurveda: –

KshudraSwasa (Difficulty in breathing), Trit (thirst), Moha (Delusion), Sweda (sweating), Dourgandhya (foul smell from body), Alpaprana (less longevity), Alpamaithuna (poor sexual activity)

Complications described in Ayurveda Samhitas: –

Arshoroga, Atisara, Bhagandhara, Jwara, Kamala, Kasa, Mutrakricchra, Kushta, Prameha pidaka, Sleepada, Urusthamba, Vruddhi roga, Sanyasa, Vatavikara etc.

Line of Ayurveda management: –

• According to Ayurveda, sthoulya mentioned under santharpanottha vikara (Diseases due to over nourishment) and it should be treated with apatarpana chikitsa (Reduction therapy).
• First & foremost line of treatment is Nidanaparivarjanam (Avoidance of causative factors).
• Tridoshahara aharavihara, especially alleviation of Samanavayu, Pachaka pitta, and Kledaka kapha along with reduction of medodhathu by increasing dhatvagnis should be the main goal of treatment.
• The Line of treatment for obesity can be divided into: –

1. Samsodhana (Bio purification therapy)
2. Samsamana (Alleviation therapy)

• Nitya langhana (reduction therapy) is advised, according to dehabala and vyadhibala.
• Types of langhana include i.e. Vamana (Emesis), Virechana (Purgation), Vasti (Enema), Pipasaveganigraha (Control of thirst), Atapaseva (Exposure to sun heat), Upavasa (Fasting), Vyayaama (Exercise), Pachana (Intake of digestants) etc.
• Rukshana Chikitsa (Drying therapy) mentioned under Shad-vidhopakrama also can be utilized e.g. Ruksha Udwarthana (Dry powder massage).
• Lekhaniya gana dravyas (Drugs with scrapping action) can be also utilized.
• Pathya aharavihara (wholesome food & regime) also well appreciated.

Lifestyle changes: –

1. Practice of Yoga asanas e.g. Suryanamaskara, Pavanamuktasana
2. Adopting regular eating patterns.
3. Substitute sugar with artificial sweeteners.
4. Avoidance of sweetened beverages, snacking etc.
5. Use of following things, (as eatables for daily) advised: –
6. Triphala (Nellikka, Kadukka, Thannikka)
7. Kulatha (Horsegram)
8. Madhu (Honey)
9. Abhaya (Kadukka)
10. Godhuma (Wheat, Oats etc.)
11. Venuyava (Bamboo seed)
12. Ushnodaka (Hot water)
13. Walking rather than driving to work
14. Swimming is advised.
15. Maximise physical activities.