obesity
Ayuivedic literature has given enormous importance to this condition by giving obesity the name Sthaulya or Me- doroga. Tliis condition has more to it than meets the eye in that it can result in many serious, and potentially deadly, health problems. Sthaulya represents a multifaceted association stuck between genetic, psychological, metabolic lifestyle and socio-economic and cultural factors.
It is one of the most distressing medical situations in present times, which has acquired the status of an epidemic, a widespread menace, cutting across borders and socio-economic strata. The risk of obesity in India is highest in the 20 per cent bracket of the populace that consumes 80 per cent of visible dietary fat. School surveys in Indian cities show that 30 per cent of adolescents from India’s higher economic groups are overweight and a Sri Lankan study has shown that 14 per cent of urban school children are overweight, two thirds of whom are from families with high income.
Obesity in American adult population has increased fr om 14.5 per cent (between 1976 and 1980) to 30.5 per cent (between 1999 and 2000). As many as 64 per cent of U.S adults above 20 years of age were overweight between the years 1999 and 2000. Tliere is also statistics on the increasing occurrence of overweights in rural areas in the last 10 years.
Obesity (sthaulya) is defined as the unusual and excessive accumulation of fat (medas) in the body. An obese individual characteristically presents himself/herself with protuberant tummy, bulky, shaking, buttocks and breasts. Obesity is basically a Sant ar pan a janya vyadlii; meaning, it is a malady caused by excess ingestion of food stuff and less utilisation. Mainly, factors which increase Kapha dosha and Medo dliatu (fat) are accountable for the causation of illness. Intake of more and more sweet substances junk food, heavy and oily items and physical inactivity lead to the morbidity of Kapha dosha and Medo dliatu.
As the properties of ingested food and Medo dliatu are akin, the ahara rasa (essence of food) in a straight line gets converted to Medo dliatu, leading to impaired bio- transformation at the tissue level. Due to this, other bodily tissues will not be receiving adequate nourishment and the medas (fat) exhibits a precise affinity to get deposited in certain specific sites in the body like abdomen, buttocks and breasts. This type of formation of medas is not considered as a physiological process, as meda is abadlia (not compact) in nature and excess in quantity. Presence of family history may hasten this pathological condition.
Ayurveda marshals the clinical indications of obesity meticulously: phimpy face, protuberant belly, bulky breasts, profound buttocks and larae tliialis. The oatient will have augmented hunger and thirst Exertional dyspnea and excess sweating with malodour are the usual signs. Generalised debility, laziness, reduced physical activity and less immunity may also be there.
They will fall easy prey to infectious diseases, have trouble in sexual performance and fertility, and be more susceptible to vata vikara like cerebro vascular and cardiovascular disorders, arthritis and diabetes mellitus. Finally, impaired anabolic process and decreased life expectancy are the consequences of untreated Sthaulya roga. All tliis clinical picture is mainly attributed to the morbid medas (fat), which is involved in the pathogenesis of Sthaulya.
In modern medicine, obesity is defined as an abnormal growth of the adipose tissue due to either an enlargement of fat cell size (hypertrophic obesity), or an increase in the number of fat cells, (hyperplastic obesity), or a combination of both. “Overweight” is usually due to obesitv. But it can arise from other causes also such as abnormal muscle development or fluid retention.
According to the fat distribution pattern in the body, obesity is classified into android obesity and gynoid obesity, hi android type,
there is more fat distribution in the abdominal region. As there is more visceral fat in this type, it is potentially more dangerous. People with this type of obesity are more prone to develop problems like altered fat metabolism, fatty liver, cardio-vas- cular diseases, etc. In gynoid type of obesity fat is evenly distributed around the periphery of the body and it is less dangerous compared to android obesity.
Causes
Obesity may occur at any age. Nowadays, childhood obesity is more prevalent due to change in lifestyle.
But, generally, the chances of getting obese increase with age. Obesity is more common in women and the state known as ‘overweight’ more prevalent among men.
Sedentary lifestyle, inactive or less active recreations like watching TV, video games, etc may act as contributory factors, along with genetic factors. Faulty eating habits play an important role in causing obesity. They include eating between meals, untimely food, improper selection/conibination/com- po sition and intake of food before the complete digestion of the food already taken.
Emotional disturbances like anxiety, depression, frustration, etc, predispose people to obesity as they may eat more, more frequently. Hormonal imbalances and alcoholism are also considered major etiological factors.
Management.
Ayurveda gives more importance to pathya (suitable diet & activities) than ding therapy. It is said that most of the diseases can be controlled or cured by observing pathya. A ding therapy without pathya has got minimum curative effect. In lifestyle diseases like obesity, following the prescribed pathya has got more importance than dmg therapy.
The general approach in the management of obesity should be kapha samana (pacifying kapha) vata samana (pacifying vata), me- do samana (reducing fat), athyagni samana (alleviating the excessive digestive fil e) and apatharpana (restricting nourishment). That these therapies are more or less contradictory to one or the other makes the treatment veiy difficult and complicated.
Generally, anything used in obesity should have the following actions viz. kapha samana, niedohara,aama paachana (neutri- lising toxic metabolites), athyagni samana, srotlioshodhana (purifying the channels/cl earing transport), virookshana (increasing rooksha guna) and chedana (removing fat from tissues/srotases). The diet should be predominant in katu, tliikta and kashaya rasas. It is mentioned that the food substances used in obesity must be heavy to digest, but not nourishing in nature.
Grain such as barley, green gram, pigeon pea, horse gram and old bamboo rice are indicated against obesity. Poppy of paddy, Trikatu, brinjal (fried without oil), cardamom, chingata fish (a small, less fatty fish variety), leafy greens and oils such as mustard oil and safflower oil are also indicated. Intake of small quantity of sesame oil in empty stomach early in the morning is also beneficial against obe- sity. Food prepared of barley and Shyaamaaka (a type of medicinal grass) or barley and broken wheat is recommended as the main diet.
Beverages such as honey, honey water, arista, khadira saara jala, asana saara jala, hot water, butter milk (rooksha takram-with fat removed), masthu (whey) and mandam (chained water after cooking rice) are highly useful. Taking water/beverages before meals and eating only after the food already taken has been digested completely also help.
Moderate exercise is better than heavy rigorous exercise to get rid of medas. Half an hour to one hour of walking per day and moderate physical activity, coupled with yoga practices, will be sufficient to burn excess fat.
Different types of fasting can be practised according to need. Better to observe fast for a day in a week.
Udvartana (powder massage done opposite to the direction of hair roots) is a very commonly done therapy in obesity, (sse stoiy).
Sunbath is indicated for obese persons as it eliminates metabolic toxins, normalises agni (digestion & metabolism) and digests a am a (toxic metabolites).
Ayuivedic purificatory therapies like vamana (medically-induced vomiting) and virechana (medically-induced purgation) can be performed periodically (it depends on suitability) if there is a tendency to become obese.
Engaging in activities increas- ing satwa guna and reducing tamo- guna of mind helpsm obese persons as they give mental control and, thereby, reduce the tendency to indulge in worldly pleasures. Engaging in spiritual activities and practising satwik (less spicy, vegetarian) food also helps bring down excess fat.
Increased mental activities (positive and creative) will reduce the tendency to become obese. Sleeping in less comfortable bed (to reduce excess sleep), frequent sexual intercourse and keeping awake at night are the other usefill practices helpful in controlling obesity.
Foods such as milk and milk products, maasha (black gram), fish, meat, sugars and jaggery are to be reduced. Avoid full stomach food and intake of a lot of water after food.
Internal ding therapy is supplementary to diet and activities. Dings like Varanadi kwatha, Vara di kwatha, various preparations of Silajit and Gugguhi are the commonly
