Part 1

Every other advertisement on the internet or the newspapers, promises of that ground breaking invention which can free the overburdened populace of this country from shackles of those extra kilos. Indeed, obesity is a vexing problem for the whole world. For developing countries like India, morbid obesity has not yet become a public health priority. As India is, in our own eyes, still a country of poverty, hunger and malnutrition; yet statistics suggest otherwise. India, which is already the third most obese country in the world, is showing increasing incidence of over-weight children and adolescents in urban areas. However, experts say the prevalence is still far lower in rural Indiawhich again is self-explanatory owing to the erratic lifestyles our urban populace has embraced. In the past, many people thought that obesity was simply caused by overeating and under-exercising, resulting from a lack of will power and self-control. Although these are significant contributing factors, we now recognize that obesity is a complex medical problem that involves genetic, environmental, behavioural, and social factors too.

Ayurved has categorically classified bodily disorders in two kinds, SANTARPANJANYA & APATARPANJANYA. The former ones are caused due to faulty over-nutrition of the body, whereas the latter ones by under-nutrition. Obesity would be ranked first amongst the disorders which fall in the group santarpanjanyavyadhi, with the likes of diabetes, hypertension and heart diseases. The  conventional  concept  of  etio-pathogenesis,  prognosis,  and management  of  obesity  is  very  similar  to  the MEDOROGA/STHAULYAROGA  of  Ayurved,  which  was  conceived  in  1500 BC  by  Acharya  Charaka.Meda is one of the 7 body building entities known as DHATUS and can be loosely correlated to the adipose tissue. “Obesity” or MEDOROGA is a state of excess adipose tissue or fatty mass whereas “Overweight” refers to an excessive amount of body weight that includes muscle, bone, fat, and water which can be termed as STHAULYA.

The basic pathology lies in the faulty metabolism of an obese individual. According to Ayurved, all the 3 doshas, particularly kaphadosha, the Dhatus and the Malas (the bodily wastes) have a role in the pathology. As said earlier the body is made up of 7 dhatus namely, Rasa, Rakta, Mamsa, Meda, Asthi, Majja&Shukra. Ayurvediya physiology explains that these 7 dhatus are formed& nourished from the previous dhatu in the succession. These dhatus are formed from the AHAR RASA which is formed due to the action of AGNI (digestive fire) on the food that we eat. If there is any issue with the AGNI naturally it will have its impact on the AHAR RASA and then the subsequent dhatus. So,primarily RASA dhatu which is the first of all the dhatus is deranged owing to imbalance in AGNI, causing the pathology to flow through the dhatus successively. Normalcy of Rasa (which can be correlated with the blood plasma) which is highly nutritive in its properties is responsible for being overweight or underweight. If Rasa is not formed properly the other dhatus are also affected gradually.

So in the pathology of MEDO-ROGA,Medodhatu receives unchecked nourishment (due to innate reasons) and thereby depleting other dhatus and degrading them. As a result, we see excessive nourishment and accumulation of Meda, but the increase in bulk doesn’t correspond to increase in the energy levels, on the contrary, there is lack of energy and the overall feeling of wellbeing is lost.This fact is conveniently forgotten today while prescribing irrational diets and other regimen while managing obesity. Hence, while cutting down on the calories we also cut down on essential nutrients worsening the situation. I also happened to mention the role of MALA (wastes) in obese patients. Often we see associated constipation, excessive or no sweating or reduced urination in MEDO-ROGI, which are manifestations of nothing but imbalanced metabolism. It is indeed difficult to explain these complex physiological processes in layman’s language, but the idea behind this is to underline the fact that whatever external treatments and methods we apply over the body are futile unless the internal mechanism is corrected.

Part 2

Acharya Vagbhat has explained 3 kinds of sthaulya- mild, moderate and severe. These could also be interpreted as stages if early intervention is not done. The characteristics of an obese patient are- inordinately increased fat and flesh, pendulous buttocks, belly and breasts andlower energy levels. There is inconsistent appetite, increased thirst, excessive sweating usually, breathing difficulties, lesser sexual drive and lack of enthusiasm. Usually Kapha prakriti individuals are likely to suffer from obesity and have difficulty in losing weight too.

We all know that when the body’s calorie intake exceeds the amount of calories burned, it leads to the storage of those excess calories as free fatty acids. This physiological system, orchestrated through endocrine and neural pathways, permits humans to survive starvation for as long as several months. However, in the presence of nutritional abundance (SANTARPAN) and a sedentary lifestyle, which in turn is influenced by genetic endowment, the system increases adipose energy stores and produces adverse health consequences such as obesity.

Environmental and behavioural factors have a greater influencetoo along with, consuming excess calories from high-fat foods or food which is oily-heavy-greasy and Increases kapha and lack of physical activity over the long run will lead to weight gain. Psychological factors may also foster obesity. Low self-esteem, guilt, emotional stress, or trauma can lead to overeating as a means to cope with the problem.Certain medical conditions such as binge eating disorder (BED), Cushing’s disease, and polycystic ovary syndrome can also lead to weight gain and obesity. BED is an eating disorder where a person has recurrent episodes during which the individual eats a large amount of food quickly and feels a lack of control over this eating. Also eating without being hungry, over-eating irrespective of appetite, erratic schedules of eating and sleeping, mindless eating invariably hinder the process of digestion and eventually disturb metabolism of an individual.

As said earlier we have to rationally analyse the causes of this condition and an approach which facilitates individual-patient-assessment is mandatory. Crash diets, OTC medications, supplements, irrational workouts should come under a scanner as there is a higher probability of damaging the system in the quest of shedding those extra kilos and a higher rate of recurrence. Being a holistic system of health care, Ayurved has emphasized the psycho-spiritual dimensions in its philosophy; mere medications without holistic healing are not advocated. In the subsequent parts let us know more about the consequences of obesity and its holistic management.

To be continued.

Dr. Sujal Torgal Patil


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