Sthaulya (Obesity) is one among the major diseases of Modern era. In the Modern era with continuously changing lifestyles, environment and faulty dietary habits, man has become the victim of many diseases. It is a bitter truth that on this earth on one hand Millions of people do not get enough food and roam in a skeletal appearance while on the other hand, there are many more who, besides overeating, lead a sedentary life to march towards an untimely death. The industrialization, stress during the work, lack of exercise, in-appropriate dietary habits like daily use of fast food, Frozen fruits, increased quantity of soft drinks and beverages as well as canned foods haveresulted into this morbidity.
Obesity is defined as a condition of abnormal or excessive fat accumulation in adipose tissue, to the extent that health becomes impaired. The amount of excessive fat in absolute terms, and its distribution in the body – either around the waist and trunk (abdominal, central or android obesity) or peripherally around the body (gynoid obesity) – have important health implications.
Charak Samhita has described Sthaulya under “Ashta Nindit Purusha” (eight despicable personalities). Acharya Sushrut has narrated that Sthaulya Roga is caused due to “Dhatvagnimandya” improper digestion. Vruddha Vagbhatta and Vagbhatta have elaborated sthaulya on the basis of formation of Ama (formation of undigested food particles regularly) and disturbance of the process of Dhatu Parinama. i.e. inter cellular metabolism and mechanism of Agni, which later on has been understood as process of metabolism in modern era.
The causes of obesity are distributed in three main groups according to modern medicine.
1. Exogenous: Where the chief cause is excessive appetite or over feeding. Over eating, drinking, and Smoking.
2. Endogenous: Where endocrine factors are important.
3. Miscellaneous : A number of factors are known to be associated with its development, which are taken under this heading like psychological factor, environmental factor, drugs, heredity etc.
The body mass index (BMI) is a simple and commonly used parameter for classifying various degrees of obesity. It is derived from the weight of the individual in kilograms divided by the square of the height in metres (kg/m2).
• A BMI of 25 to 29.9 is defined as a “Pre-Obese.
• A BMI of 30 to 34.99 is defined as “Obese Class I.
• A BMI of 35 to 39.99 is defined as “Obese Class II.
• A BMI of or greater than 40.00 is defined as “Obese Class III.
Measurement of the waist circumference – measured at the midpoint between the lower border of the rib cage and the iliac crest, or the waist hip ratio (WHR) provides useful indices of abdominal fat accumulation and a better correlation with an increased risk of ill health and mortality than BMI alone. An abdominal girth in excess of 108 cm (40 inches) for men and 98 cm (35 inches) for women or a WHR > 1.0 and 0.85 in men and women, respectively, are the currently accepted indicators of excessive abdominal fat accumulation which correlate with a substantially increased risk of metabolic complications.
Ayurvedic Management for Obesity: –
In Ayurveda, the general principle of management of any disorder is divided into 3 steps.
(1) Nidan Parivarjan (Abstinence from causative factors)
(2) Samshodhana (Elimination Therapy)
(3) Samshamana (Palliative Therapy)
1) Nidan Parivarjan:-
Nidana must be avoided for best management of the disease. In Sthaulya the factors i.e.Aharatmaka-Viharatmak( diet & lifestyle) causes, manas or psychological causes and other factors which are mentioned in and which are responsible for the causation of the disease should be avoided. Nowadays prolonged sitting works like more TV watching, gaming through different devices, work in office etc. are the intense cause of the disease.
2) Samshodhan Therapy:-
Therapies in which the aggravated Doshas or the excretory product of digestion are eliminated after mobilising them from their respective sites, by Urdhva or AdhahMarga from the body is known as Shodhana Therapy. It is also termed as Apakarshan.
There are two main parts of Shodhana therapyi)
i) Bahya Samshodhana(External Purification):-
Ayurveda accepts external purification like Udvartan and includes it in daily routine, by rubbing some medicine on the body. The benefits of Udavartan are Kaphahara, Medas Pravilayanam (dissolve the fat), Sthirikaranam Anganam (strengthen the body parts), Tvaka Prasadakar (nourishes skin). In Sthaulya, Udavartan removes the foetid odour, restricts the process of excessive sweating, alleviates the aggravated Doshas by function.
ii) Abhyantar Samshodhana(Internal Purification):-
According to Acharyas, patients with AtiSthaulya, Adhika dosha and Adhika Bala should be treated with Samshodhana therapy including Vamana (emesis), Virechana (purgation), ruksha Niruha (enema medicated with herbs having dry property), Raktamokshana (bloodletting) and Shirovirechana (nasal drops)etc. different procedures by Ayurveda. Though in Samshodhana therapy, Purvakarma like Snehana, Svedna and Pradhana Karma including Vamana,Virechana, Anuvasan Basti have been contraindicated to Atisthula Patients by most of the Ayurvedic texts. Oil of some herbs like Sarsapa (Brasica nigra), Tuvarak (Hydnocarpus laurifolia) and Bhallataka(Semecarpus anacardium) and Yavatitka (Andrographis paniculata) should be used. Among them mustard oil can be used for internal as well as external snehana i.e.oleation therapy .Mild fomentation is advised for Sthaulya patients.
Vamana can be used for the treatment of Sthaulya i.e. over nourished body and excessive increase of Meda,Mamsa, but only in uncomplicated patients. Though Virechana has been forbidden for patients of Sthaulya, mild Virechana is indicated for increased Pitta in body. Virechana karma is indicated for treatment of Atinidra symptom as well as Atisthaulya. Among various Virechaka dravyas mentioned in Ayurvedic texts, Haritaki (Teminaliachebula), Katuki (Picrorhiza kurrooa), Aragvadha (Cassia fistula), Trivrit (Operculinaturpethum), Danti-Dravanti (Baliospermum montanum), Snuhi (Euphorbia neriifolia) etc. are attributed to have additional Medanashaka property. Hence Virechana Karma could be applied to the patients of Sthaulya with suitable drugs among these.
Asthapan Basti particularly Lekhan Basti (curetting enema) is highly recommended for management of Sthaulya which can be applied under supervision of specialities. Tikshna Basti is considered as most suitable for chronic and complicated disorders like Sthaulya. Basti itself is the complete treatment for derangement of vata and further admixture of dry, hot and pungent herbs with Basti contributes to alleviate Kapha and Meda. Lekhan dravyas and Lekhan Basti are the substance which can cause absorption or extirpation of Dosha, Dhatu, Mala and emaciation of body is called as Lekhan and the Basti prepared with Triphala Kwath is termed as Lekhan Basti. Lekhan or Karshana Basti helps to remove abstraction of Meda, Kapha and Kleda from Srotas by its potency
and helps to alleviate vitiated Vata and normalize the function of Agni and Vayu.
Basti prepared with Taila, Gomutra, Kanji, and Saindhava, Erandamuladi,Kaphanasaka Basti, Lekhana Basti, Madhutailik Basti etc. can be practised for management of Sthaulya. Rakta Mokshana may be applied for patients of Sthaulya, more specifically in the patient with Raktagata MedoVruddhi.
3) Samshamana Therapy :
In Ayurveda Langhana (reducing therapy) and Rukshana (drying therapy) can be administered for Samshaman purposes in Sthaulya. Shaman Chikitsa can be implemented through seven different ways i.e -Deepan (carminatives), Pachana (digestives), Kshudha- Trit nigraha (suppression of hunger and thirst), Vyayama (physical labour), Atapasevan (sun bath), Marutsevan (exposure to breeze).
1. Langhana is administered in diseases due to excessive nourishment, in disorders emerging from the stomach, in Kaphajadisorders, in RasajaVikara and it is the best remedy advised in Sama Roga. According to general principle for the management of sthaulya alleviation ofVata, Pitta and Kapha especially Samana Vayu, Pachaka Pitta and Kledaka Kapha along with depletion of Medodhatu increasing Medodhatvagni is the main aim of treatment in Sthaulya.
2. The Deepan dravyas are dominated by Agni and Vayu Mahabhutas which are anti to the constitution of Meda and Kapha. Deepan therapy is efficacious in Sthaulya because apart from digesting Ama and Apakva meda, it has the additional property to potentiate the fires i.e.Agni.
3. Kshudha Nigraha or Exercising control over one’s appetite is one of the age-old therapies practised among the Indian masses. Fasting is one type of “Nidana Parivarjan Chikitsa’’ because the food is the main source of Nutrition for Meda Dhatu. Fasting controls the overproduction of meda dhatu. The digestive power absorption of the food, both are stimulated in Sthoola Purusha. So the person digests food quickly, but if he is deprived of the food, at the time of his need, the aggravated Vayu and Agni may lead to serious complications. Looking to this possibility it is advisable to give a small quantity of Laghu and ruksha Aahara in place of complete or severe
starvation, so that the agni gets fuel in the form of food and ultimately checks the overproduction of Meda.
4. Trishna Nigraha – Drinking of cold water in large quantities depresses the Jatharagni by adding to the liquidity of Pitta. It also increases the metabolic byproduct, Kleda. So an obese person should avoid sweet and soft drinks, nutritious fruit juice and cold water. Only utilisation of UshnaJala or Lukewarm water can control obesity.
5. Vyayam – Importance of Vyayam or physical exercise mentioned as a Routine (Dincharya), has been described since centuries in Sthaulya. Most of the Acharyas described Avyayama is cause of obesity and in the management of Sthaulya all have given more importance to Vyayam. So, Vyayam works as Nidana Parivarjana as well as it melts the excessive fat. “Sharir ArdhaSaktya” (excercising till the body gets tired of half of its capacity) is the single line formula of doing Vyayam.
Benefits of exercise include:
• Reduces extra fats all over the body.
• Improves blood sugar control and increased insulin sensitivity (decreased insulin resistance).
• Reduces bad cholesterol levels like triglyceride etc and increase good cholesterol like HDL levels.
• Controls blood pressure as well as cardiac problems.
• Regulates all the hormones in the body that make people feel good.
6. Atapasevan enhances Ushma in the body. This raised body heat reduces Meda by Vibhajana and Vilayan.
7. The word Maruta is the synonym of the Vata. By Vatasevana, the ruksha guna of Vata reduces Kleda and Kapha by Shoshana and Stimulation Jatharagni.
Some Samsamana preparations like Guduchi – Bhadra Musta, Triphala, Takrarista, Makshika, VidangadiLauha, Bilvadipanchmula and Silajatu with Agnimanthsva rasa are advised to practise for a prolonged period due to chronic consistency of the disease. Guduchi and Triphala are advocated due to its Tridoshahara properties, which indicate that all the TridoshaharaDravya with additional Medanashaka properties can be tried for Sthaulya management.
As earlier mentioned Samtarpana and Apatarpana are two opposite actions and its resultant disorder Sthulata and Krishata are two opposite conditions. So, etiological factors of Karshya can be taken as line of treatment for Sthaulya.RukshAnnapanaPrayoga, Langhana, Pramitashana, Kriya Atiyoga, Shoka, NidraVega Vinigraha, RukshSnana, RukshUdvartan, Abhyas, Krodhaetc are the causative factors of Karsya which can be practised as line of treatment for Sthaulya. Pramitashana i.e.MatraAlpasyaAshana which can be taken as intake of low calorie and low quantity diet. (LCD).
Diet Advice:-
A safe and effective long-term weight reduction and maintenance diet has to contain balanced, nutritious foods to avoid vitamin deficiencies and other diseases of malnutrition.
• Eat more nutritious foods that have “low energy density.” Low energy dense foods contain relatively few calories per unit weight (fewer calories in a large amount of food). Examples of low energy dense foods include vegetables, fruits, lean meat, fish, grains, and beans. For example, you can eat a large volume of celery or carrots without taking in many calories.
• Eat less “energy dense foods.” Energy dense foods are high in fats and simple sugars. They generally have a high calorie value in a small amount of food. Fat contains twice as many calories per unit weight than protein or carbohydrates. Examples of high-energy dense foods include red meat, egg yolks, fried foods, high fat/sugar fast
foods, sweets, pastries, butter, and high-fat salad dressings. Also cut down on foods that provide calories but very little nutrition, such as alcohol non-diet soft drinks, and many packaged high-calorie snack foods.
• Foods having hot, bitter and astringent tastes can be used for treatment of Sthaulya. Administration of Shilajatu, Guggulu, Gomutra, Triphala, Loha Raja, Rasanjana and Madhu in proper dose and duration is also advised. Madhu possesses Guru and Ruksh properties, hence it is ideal for management for Sthaulya.
After discussing all the facts we can come to a conclusion that obesity is a condition or disease which is achieved by faulty diet and faulty lifestyle with psychological conditions. Therefore, Ayurvedic advice is more beneficial for controlling the condition without regaining it.
