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Introduction

Sthoulya (Obesity) is defined as abnormal or excessive fat accumulation that presents a risk to health. A crude population measure of obesity is the body mass index (BMI) , a person’s weight in KG, divided by square of his/her height in Meters.

BMI- more than 25 is overweight

BMI- more than 30 is obese

Sthoulya is included under eight undesirable conditions (Ashtau Nindita)[1] , Shleshma Nanatmaja[2] , Samtarpana Nimittaja [3] , Atinindita [4] , Ati Brihmana Nimittaja [5] and Bahu Dosha Janita[6] Vikara. Moreover Sushruta has emphasized on metabolic disturbances (Dhatvaagnimandya) in the etiopathogenesis of Sthoulya.[7] The patient of Sthoulya exhibits very strange phenomenon. Their appetite is more [8] and whatever they eat is rapidaly digested, which indicates hyperfunctioning of the Jatharaagni. Besides this, they suffer from laziness, may be due to under supply of energy, which may be due to hypo functioning of Bhutaagni.Further Dhatvaagni also seems to be disturbed, as in Sthoulya mainly Medo-Dhatu is formed and there is deficiency of other Dhatu.[9] Hence, it can be inferred that in Sthoulya, Jatharaagni is Tikshna,Bhutaagni is Manda and  Dhatvaagni is disturbed in their respective functions. On the basis of the above-mentioned facts of pathogenesis of Sthoulya, it can be said that Apart from prescribing treatment to Sthoulya, Ayurveda also emphasizes on an ideal method of healthy living with yogya ahar, vihar & yoga.

METHODS & MATERIALS

In different ayurvedic texts, various treatments are mentioned as medohar, aptarpaniya, karshniya and lekhniya. .[10]

Treatment:

Treatment includes – 1) Nidan Parivarjan, 2) Sanshodhan, 3) Sanshaman

1) Nidan Parivarjan – It says that the root cause of samprapti process, nidan must be avoided for best management of the disease. The following nidan should be avoided.

Nidan of sthoulya-

1. Aharatmak nidan (dietary)
2. Viharatmak nidan (regimens)
3. Manas nidan (psychological )
4. Anya nidan (other factors)

2) Samshodhana – Aggrevated doshas are eliminated after mobilizing them from their respective sites by urdhva or adhaha marga from the body is known as shodhana therapy.

Two types- a) abhyantar shodhan- vaman, virechan, nasya, basti , raktamokshan

                   b) bahya shodhan- udavartan, avagah, parishek , lepan,etc.

3) Shaman therapy- This therapy can be implanted through seven different ways- deepan, pachan, kshudhanigraha, trishanigraha, vyayam, atapasevan, and marutsevan.

Compound drugs: Triphala guggul, varunadi ghanvati, medohar guggul, navak guggul, arogya vardhini, mahasudarshan ghan vati, etc.

Following the regimens advised in dincharya & ritucharya.

Yoga and Pranayama- Paschimottanasan , halasan, bhujangasan, trikonasan, sarvangasan, etc.

Discussion

Aharatmak nidan (dietary)

1. Quantity of food intake

Excess quantity of food intake without considering the status of Agni (digestive fire) is one of the important causes of Sthoulya. Maharshi Charaka has mentioned Atisampurana as the cause of Sthoulya .[11]

2. Water intake immediately after food

taking  water immediately after having food leads to stoutness of the body. Taking little quantity of water in the mid of the meals is best to maintain the healthy status of body.[12]

3. Liking for sweet taste food

Intake of Madhura Ahara (sweet food) is mentioned as cause of Sthoulya.[13]

4. Frequency of taking dairy foods items weekly

Intake of milk and milk products causes Kapha and Medo Vriddhi which is an important cause of Sthoulya

5. Intake of Ghee and Ghee based sweets

Ghrita is Madhura, Shita and increases Kapha Dosha.[14] Excess intake of Ghee is mentioned as a causative factor for Sthoulya . This is also one of the important causes of Sthoulya .

6. Frequency of fatty food intake

This is also found that people prefer to take oily and fried food in all the three times that is breakfast, lunch and dinner. In Ayurvedic classics Snigdha Ahara Sevana (intake of unctuous food) is mentioned as etiological factor for Sthoulya [15]

Viharatmak nidan (regimens)

1. Occupation

The occupational status of a person determines his/her life style. Nowadays housewives are making use of electronic machines and gadgets for most of the household works due to which the physical activity is minimized. Another reason may be as the females are more involved in caring family members and due to that they neglect their own health needs. Similarly private sector employees are having sedentary type of occupation which is associated with higher risk of Sthoulya

2. Socio-economic status

Previously it was considered that Sthoulya is a disease of affluent society but the trend have changed and Sthoulya can be seen even in lower as well as middle class people. This is due to the fact that obesity is related with faulty lifestyle including dietary habits and not specifically with the income and socio economic status

3.Avyayam

The energy balance model of adiposity stipulates that weight gain occurs if caloric intake exceeds energy expenditure.[16] Obesity occurs when energy intake from food and drink consumption is greater than energy expenditure through body's metabolism and physical activity over a prolonged period, resulting in the accumulation of excess body fat.

4. Involvement in physical activity

Involvement in physical activities has decreased overtime due to technological advancement. Lack of physical activity and sedentary life style is mentioned as the cause of Sthoulya.[17,18 ] Maximum patients rarely or never do exercise or brisk walk or Yoga, Asana etc., Even to cover the short distance they prefer vehicles instead of walking. To maintain the dose balance, our energy expenditure of body  should be in accordance to our food intake but here, most of the patients were found to be involved in fatty food intake, that also in excess quantity but their involvement in physical activity is very less and that was found to be the strong etiological factor for Sthoulya .

5. Sleep pattern

Like proper diet, proper sleep is also essential for the maintenance of the body. Corpulence and emaciation are specially conditioned by proper and improper sleep and diet.[19] Excess sleep and day sleep are mentioned as the causes of Sthoulya.[20,21,22] Sleeping in Sukha Shayya (comfortable soft bed) is also an etiological factor for Sthoulya [23]

Manas nidan (psychological )

The rapid increase in the prevalence of obesity suggests that psychological and behavioural factors, rather than biological factors, are primarily responsible for this trend.[24] Obesity is a psychological as well as physical problem. Individuals who suffer from psychological disorders (e.g., depression, anxiety, and eating disorders) feel more difficult in controlling their consumption of food, exercising an adequate amount and maintaining a healthy weight. Food is used as a coping mechanism by those with heigh weight problems, particularly when they are sad, anxious, stressed, lonely and frustrated.

Anya nidan (other factors):

1. Age and gender.

It is observed that majority of the patients are in between 20-40 years age group. It is due to the increasing trend of sedentary lifestyle  incidence of Sthaulya increasing. According to Ayurveda Madhyama Awastha is the stage of life when absolute development of body  Dhatu (fundamental tissue) takes place. Modern evidences also supports the same observations i.e., excess weight gain usually achieved during middle age.[25] A number of physiological processes are believed to contribute to an increased storage of fat in females. Females have a tendency to channel extra energy into fat storage while males use more of this energy for protein synthesis.

2. Family history

It is important to note a fact that, the ancient physicians were able to recognize the role played by one's heredity causing obesity and technically termed the genetic predisposition of obesity as Beeja-svabhava of Atisthaulya. Maharshi Charaka has clearly mentioned Beeja svabhava as an etiological factor of Sthaulya.[26] Role of the genetic and chromosomal abnormalities in the pathogenesis of Obesity has also been proved by the modern science. Moreover the offspring inherit the physical and eating habits of their obese mother or father which leads to the excessive weight gain, that can be explained by genetics.[27,28]

Conclusion

We need to reassess entire lifestyle(sadvritta) if we want to avoid problems associated with obesity. Modern drugs have lot of complications hence it is better to follow Ayurvedic principles for healthy lifestyle. Along with aharatmak, viharatmak & manasik nidan parivarjan , we can combine this healthy lifestyle with safe & effective treatment of Ayurveda and proper diet, yoga to prevent and manage Sthoulya (obesity) . As Ayurveda believes in prevention is better than cure, if we follow yogya ahar & vihar mentioned in Swasthvritta, one can prevent the Sthoulya.

I am thankful to all my college staff for supporting me to write this article. I am also thankful to the supreme knowledge of Ayurveda.