Mar 2, 2009
The Nature has taught the man how to be healthy before the science has discovered the laws of health. But, it is an irony of the fate that, on this earth on one hand Millions do not get enough food and roam in a skeletal appearance while on the other hand, there are many more who, besides over eating lead a sedentary life to march towards an untimely death.
Sthaulya (Obesity) is one among the major diseases of Modern era. In Modern era with continuous changing life styles and environment, changed diet habits, man has become the victim of many disease caused by unwholesome dietary habits and Obesity is one of them.
Obesity is a blessing of the Modern age of Machines and Materialism. It occurs as a result of lack of physical activity with increased intake of food. The industrialization, stress during the work. Dietary habits, lack of exercise & various varieties among the daily diet e.g. fast food, Freezed fruits, increased amount of soft drinks and beverages, canned foods results into the clinical entity which we can call as Obesity.
Obesity is the only one disease which is gaining more and more attention of scientists at global level. Many institutions and Medical schools are making efforts to find a perfect remedy for this burning problem. Curiosity is one of the noblest instincts of man, the endless desire of man for his knowledge. By this time, many countries are making an effort into this field of research. Many theories have been put forward with many new hypotheses describing the exact aetiopathogenesis of Sthaulya or Obesity.
Obesity is such a physical state where Hypertension, Osteoarthritis, Diabetes Mellitus, Cardio Vascular accidents impotency and many other grave complications are the Vulturous invited. The long term dangers of Obesity are like a sword hanging over one's head tied in a weak thread which can strike at any time and create numerous difficulties and boundless miseries.
A definition of Swastha purusha as given by Cha.Su. 21/18-19 and Su.Su.15/48, A healthy body is the only one media to achieve the ultimate goal among the chaturvidha purushartha. Acharya Sushruta also said that Madhyama Sharira is the best but Ati Sthaula (too obese) and Ati Krisha (too thin) are always affected with some complaints (Su. 15/42). Acharya charak has thrown light on the eight varieties of impediments which are designated as Nindita Purusha (inferior person), Ati Sthaulya comprises one of them.
Definition
A person having heaviness and bulkiness of the body due to extensive growth especially in Udaradi (Abdomen etc.) region is termed as "Sthula" and the state (Bhava) of Sthula is called "Sthaulya".
Ati Sthula has been defined as a person, "who on account of the inordinate increase of fat and flesh, is disfigured with pendulous, buttocks, belly and breasts and whose increase bulk is not matched by a corresponding increase in energy”
Literary, the word obesity is derived from Latin word "Obesus" from "ob" by reason of and "Edo", I eat which means having eaten. The word obesity is referred to excessive states of over weight and is the clinical term used to describe this condition.
Obesity can be said as excess deposition of adipose tissue is obesity. A body weight 20% or more above desirable weight for age, sex and height is regarded as obese. A recent National Institute of Health consensus conference defined obesity as Body Mass Index greater than 27 kg/m². Now a days obesity is defined at or greater than 25 kg/m² BMI.
Parks has given obesity may be defined as an abnormal growth of the adipose tissue due to an enlargement of fat cell size (Hypertrophic obesity) or an increase in fat cell number (hyperplastic obesity) or a combination of both.
CAUSATIVE FACTORS OF STHAULYA
Ayurveda describes many etiological factors of sthaulya roga in their Samhitas which are related to all aspects at life and affect the body from out side and inside also. The hereditary (Bijadosha) component besides dietetic, regimental and psychological factors in the causation of Sthaulya have been described by Charak Samhita . These are most of exogenous type.
Except these factors, the components which may vitiate meda(fat) and shlesma (kapha) could be considered as a causative factors of sthaulya. Defective intercellular metabolism had been considered as main cause besides other components in etiopathology at Sthaulya.
In context with Sthaulya, exogenous causes are Meda potentiating diet and regimens where as Dosha. Dhatu , Mala, Srotas etc. come under the endogenous factors.
All the causative factors described in Ayurvedic classics can be classified into
four groups :
1. Aharatmaka Nidana ( Dietary)
2. Viharatmaka Nidana ( Regimens)
3. Manas Nidana (Psychological)
4. Anya Nidana (Others)
Aharatmaka Nidana
Ati sampurana (Over eating), Santarpana ( over nourishing), Adhyasana (over eating) Guru Aharasevana (Excessive consumption of Heavy food), Madhura Aharasevana (Excessive consumption of sweet food), Sheeta Aharasevana (Excessive consumption of cold diet), Snigdha Aharasevana (Excessive consumption of unctuous food), Sleshmala Aharasevana (Kapha increasing food), Navannasevana (Usage of fresh grains), Nava madya sevana (Usage of fresh alcoholic preparation), Gramya Rasasevana (Usage of domestic animal's meat & soups), Audak Rasa sevana (Usage of Aquatic anirual's meat & soups), Mamsa sevana (Excessive use of meat), Paya Vikar sevana (Excessive usage of milk and it's preparations), Dadhi Sevan (Excessive use of curd), Sarpi sevana (Usage of Ghee), Ikshu Vikara sevana (Usage of sugarcane's Preparations), Guda Vikara sevana (Usage of jaggery's preparations), Shali sevana (Excessive use of Rice), Godhum sevana (Excessive use of wheat), Masha sevana (Usage of Black gram), Rasayan Sevana (Aphrodisiacs), Vrushya Sevana (Rejuvenateives), Bhojanotara Jal-pana ( Drinking water after food in take).
Viharatmaka Nidana
Avyayam (Lack of physical exercise), Avyavaya (Lack of sexual life), Divaswap (Day's sleep), Asana Sukha (Luxurious sitting ), Swapnaprasangat (Excessive sleep), Gandhamalyanu Sevana (Using of perfumes garlands), Bhojanotar snana (Bathing after taking the meals), Bhojanotar Nidra (Sleeping soon after meal), Bhojanotar Aushadha sevana (Drugs after meal).
Manasvyaparatmaka Nidana
Harshnityatvat (Uninterupted cheerfulness), Achintanat (Lack of anxiety), Manasonivritti (Relaxation from tension), Priyadarshana (Observations of beloved things), Saukhyena.
Anya Nidana
Amarasa, Snigdha Madhura Basti Sevana (Administration of unctuous & Sweet enema)
Tailabhyanga (Massaging of oil), Snigdha Udvartana (Unctuous unction), Bijadoshasvabhavat (Heridity)
ETIOLOGY OF OBESITY:
The causes of obesity are distributed in main three groups according to modern medicine.
1. Exogenous: Where the chief cause is excessive appetite or over feeding.
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.
CAUSES OF OBESITY
Exogenous Endogenous Miscellaneous
Over eating Endocrine Factors Age
Dietary habits Sex
Drinking habits Occupation
Smoking Socioeconomic factors
Psychogenic factors
Environment factors
Constitution
Drugs
Hypothalamic trauma
Physical activity
Caloric balance
Heredity
Prevalence of Obesity
A number of factors influence body fat including age, sex, race, socioeconomic class etc.
Obesity is most prevalent in middle age but can occur at any stage of life. Sthaulya can emerge at any stage of life. More indulgence of Madhura Ahara by a pregnant lady may tends towards birth of a obese child and this type of childhood obesity may run for life long.
Normally the women are more prone to be obese than men. The young adult women contains fat approximately 15% of body weight and it is about more than young man. In that phase of puberty and adolescent due to hormonal changes more fat accumulates in body particularly in femoral, gluteal and breast region especially in females. Female have innate tendency and large fat cells to accumulate more fat in above regions. Moreover puberty, pregnancy, menopause and cyclic hormonal changes attributes towards obesity in females.
According to Ayurvedic concepts meda is a matrija bhava i.e. female dominant proportionate of the body, which indicates dominance of fat in females.
It is believed that obesity is a disease of only upper socioeconomic class, but it is not so various survey studies have indicated towards the increased prevalence of obesity in middle and lower socioeconomic classes. Starchy foods providing bulk of the cheap meals, and fatty foods with alcohol causes obesity in lower and upper socioeconomic classes respectively.
It is clear that the prevalence of obesity is not related with quantum of money it depends upon mode and code of life style and eating habits. Obesity may occur in any class of society which tends towards overeating and sedentary habits.
The prototypic convenient foods are preparation of fat and sugar such as biscuits. Urban population constantly consumes these foods. In addition, urban civilization also reduces the need for strenuous physical exercise. These trends increase energy intake and decrease energy output leading to obesity.
It has been demonstrated that exposure to Nicotine increases metabolic rate cigarette smoking suppresses body weight, discouraging many smokers from trying to quit. The study of williamson D.F. & others confirmed that discontinuing smoking causes weight gain in 80% at ex-smokers by about 2.3-4.6Kg. with the gain slightly greater among female than males.
Actually environmental factors are not cause of obesity but they are only sub ordinate factors of heredity. A variety of environmental factors are needed to display this susceptibility.
Studies have revealed that improper and insufficient sleep may result in obesity. Persons who sleep for less than 6 hours are more prone to obesity.
Ati Sampurna and Adhyasana can be considered as faulty eating habits. Ati Sampurana means excess food intake in a single meal, while Adhyasana means frequent food intake before digestion of a previous meal.
Obesity arises only when the intake of food is in excess of the physiological needs. If a healthy person eats only an extra slice of bread or chapati (20 gm) at breakfast, this provides a surplus of 20 gm. or 48Kcal of energy, which is stored as triglycerides. If he continues with this as a daily habit, after 10 years the store will grow up by 20 Kg and the person will become very obese. The daily offset of the energy balance needed to produce obesity is so small that the study of its etiology is beset with difficulties.
It has been found that rapid eating might influence obesity because eating faster permits, a greater intake of food before post ingestive satiety occurs. Eating with a group may course people to linger over their food, eating more than they would alone. Eating in late nights makes gain in weight.
The excessive consumption of dravyas of similar substance (Dravya samanya) similar quality (Guna samanya); or similar in action (Karma samanya) helps in the over production of dhatu. In the same way the growth of Meda dhatu is observed by excessive consumption of fatty substance due to Dravya Samanya in both of them. If either one or two or all the three properties are similar, then such substances boost up the growth of the dhatus, the result is Dhatu Vriddhi.
SAMPRAPTI (pathology);
Samprapti means the knowledge of the way in which a disease occurs and it deals with the process of menifestation of the disease by the vitiated doshas. In pathogenesis of Sthaulya, all the three Doshas are vitiated, especially Kledaka, Kapha, Pachaka Pitta, Samana and Vyana Vayu are the responsible factors for proper digestion and metabolism of food at the level of alimentary tract and body tissue Dusti of these Doshika components results in indigestion metabolic deformity and formation of Ama at tissue level as well as alimentary tract.
COMPLICATIONS:
Obesity is a type of disease which invites many major and minor diseases. It significantly shortens the life-span and is associated with an increased incidence of a multitude of major and minor diseases. By consideration of health, the simplest statistics is that, a middle aged man who is 10 Kg. over weight can expect to die roughly 4 years earlier than one of normal weight, due to severe hazards which are associated with overweight.
The relationship between body weight or body fat and medical complication is curvilinear. There is no question that severe obesity is a serious threat to life. Further more, obesity is associated, probably - causally with other significant factors for coronary artery disease such as HBP, Hyperlipidemia, Glucose intolerance as well as certain types of cancer. These disorders and obesity it self have a strong familial component. Less well-known complications include Hepatic stenosis, Gall bladder disease, pulmonary function impairment, Endocrine abnormalities, obstetric complications, Trauma to the weight bearing joints, Gout, Cutaneous disease, proteinuria, increased haemoglobin concentration and possibly immunologic impairment.
Due to increased coagulability of blood, obese individuals also constitute an increased surgical risk. So the mortality rate for various surgical procedures is also high in the obese individuals. General Anaesthesia also carries a much higher risk. In all these above mentioned hazards, perhaps the most common complication is Diabetes which in turn may lead to kidney failure.
SADHYASADHYATA (Prognosis)
Bad prognosis of Sthaulya has been described by most of the Ayurvedic classics, because if they are not duly managed, they are prone to death due to excessive hunger, thirst and complications. Moreover, lack of immune power (Vyadhi Asahatva) is mentioned as a common feature as well as serious draw back of Sthaulya so they are frequently prone to secondary diseases.
The aim of treating "Sthaulya" is at reducing Vata, Agni and Meda. Neither santarpana nor apatarpana mode of treatment is efficacious for correcting Sthaulya; because Santarpana Chikitsa pacifies Vayu & Agni; but at the same time raises Meda dhatu. On the other side Aptarpan Chikitsa reduces Meda on one hand but elevates the status of Agni and Vayu in the body. From above, it can be concluded that Apatarpana Dravyas with Gurugunas can produce the desired results. Also there is a very limited choice of drugs and diets for Sthula person and there is a greater probability of getting affected by complication.
CHIKITSA
In Ayurveda, management of any disorder is divided into 3 parts.
( 1 ) Nidan Parivarjan
( 2 ) Samshodhana
( 3 ) Samsamana
Nidan Parivarjan (avoiding causative factor) : It is the first line of treatment of any disease and it is most important line of treatment for Sthaulya also. It says that the root of Samprapti process, Nidana must be avoided for best management of the disease. In Sthaulya the factors i.e. Aharatmaka Viharatmak, manas and others which are mentioned in Nidana and which are responsible for the causation of the disease should be avoided.
Samshodhan Therapy (panchakarma theraphy): Meaning of Shodhana is Apakarshana of dosha. Therapies in which the aggravated doshas or the excretory product of digetion are eliminated after mobilising them from their respective sites, by Urdhva or Adhah marga from the body is known as Shodhana Therapy. It is also termed as Apakarshan. There are two main parts of Shodhana therapy.
Bahya Samshodhana (Udavartana, Avagah, Parisheka, Lepana) Abhyantar Samshodhana (Vamana, Virechana, Nasya, Niruha) Bahya Samshodhana :
Many Acharyas have mentioned external purification therapy for management of Sthaulya. In all classical texts, Udavartan was mentioned as part of Dincharya and for Sthaulya Raksha Udavartan was narrated by Acharyas. The benefits of Udavartan was also mentioned i.e. Kaphahara, Medasah Pravilayanm, Sthirikaranam Anganam, Tvaka Prashadakar. In Sthaulya Udavartan posses removes the foetid odour, restricts the process of excessive sweating, and alleviates the aggravated doshas by function.
Abhyantar Samshodhana :
Being a syndromic entity Samshodhan therapy is highly recommended for Sthaulya management. According to texts, patients with Ati Sthaulya, Adhika Dosha and Adhika Bala should be treated with Samshodhana therapy including Vamana, Vireachana, Ruksha Niruha, Raktamokshana and Shirovirechana.
Asthapan Basti particularly Lekhan Basti is highly recommended for management of Sthaulya by ancient Ayurvedic physicians. Lekhan or Karshana Basti helps to remove abstraction of Meda, Kapha and Kleda from Srotas by its veerya and helps to alleviate vitiated Vata and normalize the function of Agni and Vayu.
Samshamana Therapy :
Among Sad Upakrama (Six type of therapies), Langhana and Rukshana can be administrated for Samshaman purpose in Sthaulya. Saman Chikitsa can be implemented through seven different ways. Deepan, Pachana, Kshudha Nigraha, Trisha Nigraha, Vyayama, Atapasevan, Marutsevan.
Deepan and Panchana - The Deepan dravyas are dominated by Agni and Vayu Mahabhutas which are anti to the constitution of Meda and Kapha i.e. Jala and Prithvi Mahabhuta. Deepan therapy is efficacious in Sthaulya because apart from digesting Ama and Apakva Meda, it has the additional property to potentiate Jatharagni, Bhutagni and Dhatvagni.
Kshudha Nigraha - Exercising control over one's appetite is one of the age old therapies practiced 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 over production of meda dhatu. Fasting first of all halts the nutrition of Ama and thus activates the Agni and digests the Ama. As a result, Agni functions are restored and Dhatvagni gets stimulated which resists further nourishment to Medadhatu.
The digestive power absorption of the food, both are stimulated in Sthoola Purusha. So the person digest food quickly, but if he is deprived of the food, at the time of his need, the Margavarodhajanya aggravated Vayu and Agni may lead to serious complications. Looking to this possibility it is advisable to give small quantity of Laghu and Ruksha Aahara in place of complete or severe starvation, so that the Tikshnagni gets fuel in the form of food and ultimately checks the over production of Meda.
Trisha Nigraha - Excessive thirst is a symptom and also a cause of Sthaulya. Drinking of cold water in large quantities depresses the Jatharagni by adding to the liquidity of Pitta.
It also increases the metabolic by product, Kleda. So a Sthula Purusha should take lukewarm water in small quantities. Thus he should control his thirst, which aids in the phenomenon of deepan and panchana. From the word control of thirst we can arrive to the conclusion that obese person should avoid sweet and soft drinks, nutritious fruit juice and cold water.
Vyayam - Importance of Vyayam or physical exercise has been described since centuries in Sthaulya. Most of the Acharyas described Avyayam is cause of obesity and in the management of Sthaulya all have given more importance to Vyayam. So, Vyayam works as Nidana Parivarjan as well as it melts the excessive fat, deposited in the fat depots.
Atapa Sevan - Atapa sevan enhances Ushma in the body. This raised body heat reduces Meda by Vibhajana and Vilayan. It potentiates Kleda Vilayana.
Marut Sevan - The word Maruta is the synonyms of the Vata. By the Vata sevana, the Ruksha Guna of Vata reduces Kleda and Kapha by Shoshana and Stimulation Jatharagni.
Charak Samhita has been given treatment in following words. Administration of Guru and Apatarpan articles which possess additional Vata, Slesma and Meda Nasaka properties is considered as an ideal for Samasaman therapy.
Different medicaments for Sthaulya Single dugs Haridra, Katushigru, Chitraka Nirgundi, Vidang Agnimantha, Chakramarda, Madhu (honey), Guggulu, Vacha, Ativisha, Bala, Haritaki, Rasanjan, Musta.
Compound Drugs
Medoharayoga, Navak Guggulu, Varunadi Ghanvati, Triphala, Piper nigrum compounds Vyoshadhya Saktu, Lekhaniya Mahakashya, Lekhan Vati, Mahamanjisthadi quatha, Trigunadi Guggulu , Medohara Guggulu, Chitrakadi Vati, Amrutadi Guggulu, Triphala Guggulu, Vidangadi Churna, Medohara Vati.
Mineral
Shilajeeta, Vidangadi Loha, Lauha Rasayan, Badavagni Rasa, Arogyavardhini, Triyushnadi Loha, Navayas Loha.
Acharyas have widely enumerated the Laghu Anna and excessive physical activity for the patinets of Sthaulya. It is clear from the discussion on pathophysiology that the less calorie requirement is needed to these patients. Patients require to take more and more physical activity so that accumulated fat can be burnt. However white planning the treatment always it should be kept in mind that less calorie consumption (Langhana Apatarpan) and more calorie expenditure (Langhana-Apatarpan) are Vata provocative factors hence when ever Ahara Kalpa is to be derived it should be anti vata along with anti kapha for the patients of Sthaulya.
In our centre we do 21 days obesity package which include one course of panchakarma (detoxification theraphy),one course of udvarthana (Powder massage),one course of herbal enema.
Conclusion
The disease Sthaulya is well described in Ayurvedic texts. Disease has been classified under the heading of eight most denounced personalities. For explaining the pathogenesis of Sthaulya roga some important hints are available in the texts. For most is the etiological factors looking to the basic terminology used by Acharya Charak all the available etiological factors can be classified into four groups. e.g.
Ati sampuranat : Excessive indulgence in the various diet articles.
Avyayamat : Less calories combustion options of exercise.
Psychological factors : Excessive pleasure, depression etc.
Beejadoshat : Genetic / hereditary defect
The total body lipids are divided in all most all the dhatus. The Guggulu and its combination are the most widely practiced. The various Loha
preparations have also been used. In Ayurveda most of the possible complications of Sthaulya Roga have been listed and discussed.
Contact Dr Alva - Click Here
Also see: