Changes

Any course of treatment for obesity suggested by modern medical practitioners primarily includes dietary changes and physical exercise followed by anti-obesity drugs that help reduce appetite or inhibit fat absorption. In severe cases, various invasive and non-invasive surgical procedures could be prescribed - such as partial gastrectomy, gastric bypass, banding, gastric balloons, etc<ref>Puhl R, Brownell KD (December 2001): "Bias, discrimination, and obesity". Obes. Res.9 (12): 788–805. doi:10.1038/oby.2001.108. PMID 11743063. </ref>. However, [[Ayurveda]]’s approach to weight management is very different. Instead, [[Ayurveda]] advocates dietary restrictions according to the ''prakriti'' (predisposition or temperament of the patient), moderate exercise, practice of ''yogasanas'' and ''pranayama'', besides certain ayurvedic medications and bio-purificatory measures for its management<ref>Pandey A.K. (2013-2014): Conceptual background on obesity (sthaulya/medoroga) & an approach for its management through ayurveda, chapter published in a book ‘Integrative approach to metabolic syndrome’ published by Mahima research foundation and social welfare, Varanasi, UP, India, 2013-2014, p.no.-47-59. </ref>.

Any course of treatment for obesity suggested by modern medical practitioners primarily includes dietary changes and physical exercise followed by anti-obesity drugs that help reduce appetite or inhibit fat absorption. In severe cases, various invasive and non-invasive surgical procedures could be prescribed - such as partial gastrectomy, gastric bypass, banding, gastric balloons, etc<ref>Puhl R, Brownell KD (December 2001): "Bias, discrimination, and obesity". Obes. Res.9 (12): 788–805. doi:10.1038/oby.2001.108. PMID 11743063. </ref>. However, [[Ayurveda]]’s approach to weight management is very different. Instead, [[Ayurveda]] advocates dietary restrictions according to the ''prakriti'' (predisposition or temperament of the patient), moderate exercise, practice of ''yogasanas'' and ''pranayama'', besides certain ayurvedic medications and bio-purificatory measures for its management<ref>Pandey A.K. (2013-2014): Conceptual background on obesity (sthaulya/medoroga) & an approach for its management through ayurveda, chapter published in a book ‘Integrative approach to metabolic syndrome’ published by Mahima research foundation and social welfare, Varanasi, UP, India, 2013-2014, p.no.-47-59. </ref>.

The etiology, pathogenesis, clinical features and consequences of extreme leanness (''atikrisha''), as an outcome of ''rasakshaya'' (decrease of ''rasa''), ''medokshaya'' (decrease of ''fat'') and ''mamsakshaya'' (decrease of ''muscles'') have also been described in this chapter. The two basic approaches for management of ''atikrisha'' and ''atisthula'' are augmentation (''brimhana'') and depletion (''karshana'') of body tissues respectively. Various drug and non-drug modalities have been suggested for the replenishment of ''dhatus'' and their nourishment to attain good health. In this regard, ''Rasayana'' drugs help balance hormones, promote essential nutrition and enhance immunity to ''atisthula'' and ''atikrisha'' respectively. As mentioned earlier, this chapter also emphasizes the role of good ''nidra'' (sleep) in maintaining a healthy life. In fact, as per [[Ayurveda]], after ''ahara'' (diet), ''nidra'' is one of the three sub-pillars of life (''trayopastambha'') and has a significant place in preventive medicine because normal sleep helps prevent diseases and unwholesome sleep may lead to fatal diseases. In [[Ayurveda]], ''nidra'' is considered a ''brimhana'' (nourishing) agent that promotes physical and mental health and enhances immunity<ref>Vd. H.S.KHushvaha (2009). Agniveshakrita Charak Samhita, Sutrasthana-11, Varanasi, Chaukhambha Orientalia, 2009. </ref>.

The etiology, pathogenesis, clinical features and consequences of extreme leanness (''atikrisha''), as an outcome of ''rasakshaya'' (decrease of ''rasa''), ''medokshaya'' (decrease of ''fat'') and ''mamsakshaya'' (decrease of ''muscles'') have also been described in this chapter. The two basic approaches for management of ''atikrisha'' and ''atisthula'' are augmentation (''brimhana'') and depletion (''karshana'') of body tissues respectively. Various drug and non-drug modalities have been suggested for the replenishment of ''dhatus'' and their nourishment to attain good health. In this regard, ''Rasayana'' drugs help balance hormones, promote essential nutrition and enhance immunity to ''atisthula'' and ''atikrisha'' respectively. As mentioned earlier, this chapter also emphasizes the role of good ''nidra'' (sleep) in maintaining a healthy life. In fact, as per [[Ayurveda]], after ''ahara'' (diet), ''nidra'' is one of the three sub-pillars of life (''trayopastambha'') and has a significant place in preventive medicine because normal sleep helps prevent diseases and unwholesome sleep may lead to fatal diseases. In [[Ayurveda]], ''nidra'' is considered a ''brimhana'' (nourishing) agent that promotes physical and mental health and enhances immunity. <ref>H.S.Kushwaha, Charak. Sutra Sthana, Cha.11 Tistraishaniya Adhyaya ver.35. In: H.S.Kushwaha, Editor. Charak Samhita.1st ed. Varanasi: Chaukhambha Orientalia;2009. </ref>.

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=== Morbid obesity ===

=== Morbid obesity ===

In the context of ''atisthula'' and ''atikrisha'', Charak has explored these conditions from the standpoint of their diathesis, clinical presentation, and management, which is comparable to approaches taken today to the study of obesity and leanness. Suśruta has considered ''rasa dhatu'' as the main culprit for both obesity and emaciation (''rasa nimittameva sthaulyam karshyam ca'')<ref>Acharya, J.T. (translator) (1915). Sushrut Sanhita of Sushrut, Nirnay Sagar Press, Mumbai, India, p. 65, Su.Su-15/39. </ref>.  

In the context of ''atisthula'' and ''atikrisha'', Charak has explored these conditions from the standpoint of their diathesis, clinical presentation, and management, which is comparable to approaches taken today to the study of obesity and leanness. Suśruta has considered ''rasa dhatu'' as the main culprit for both obesity and emaciation (''rasa nimittameva sthaulyam karshyam ca'')<ref>Sushruta. Sutra Sthana, Cha.15 Doshadatumalkshayavriddivinjaniya Adhyaya verse 32. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. </ref>.  

Lipid precursors are acted upon by fat-specific energy (''medhodhatvagni'') for their conversion into adipose tissue (''medodhatu'')<ref>Mishra, L.C. (2003). Scientific Basis of Ayurvedic therapy, Chapter 9 Obesity (Medoroga) in [[Ayurveda]]; eBook, published by CRC press, Taylor & Francis Group.  </ref>. Vitiation of ''kapha dosha'' and excessive accumulation of fat-specific energy and waste products of adipose tissues (''kleda'') lead to dysfunction of adipose tissues. Adipose channels have two origins - kidney, adrenal and fat around them and other are visceral and omental fat (''vapavahana'')<ref>Shastri, P.K (1983), (translater), Caraka samhita, Part I, 2nd ed., Chaukhambha Sanskrit Sansthan, Varanasi, India, p. 595. </ref>. These channels draw nutrition, including lipid from the antecedent flesh and transient lipid and then convert them into a stored form of lipid. As per biomedical science, obesity is associated with increased adipose stores in the subcutaneous tissues, skeletal muscles and internal organs such as kidney, heart, liver and omentum. Adipose tissues (''medodhatu'') form a crucial link to the concept of tissue metabolism. Low levels of fat-specific energy (''medodhatvagni''), despite a normal food intake, can lead to a steady accumulation of fat and the outcome is obesity<ref>Bleich S, Cutler D, Murray C, Adams A (2008). "Why is the developed world obese?". Annu Rev Public Health29: 273–95. doi:10.1146/annurev.publhealth.29.020907.090954. PMID 18173389. </ref>  <ref>Drewnowski A, Specter SE (January 2004). "Poverty and obesity: the role of energy density and energy costs". Am. J. Clin. Nutr.79 (1): 6–16.  </ref>. The conventional system of medicine has given due consideration to certain factors such as insufficient sleep, genetic predisposition, later age pregnancy, certain medications and other epigenetic factors in the etiopathogenesis of obesity and its related disorders<ref>Keith SW, Redden DT, Katzmarzyk PT et al. (2006). "Putative contributors to the secular increase in obesity: Exploring the roads less traveled". Int J Obes (Lond)30 (11): 1585–94. doi:10.1038/sj.ijo.0803326. PMID 16801930. </ref>.(Verse 3-4)

Lipid precursors are acted upon by fat-specific energy (''medhodhatvagni'') for their conversion into adipose tissue (''medodhatu'')<ref>Mishra, L.C. (2003). Scientific Basis of Ayurvedic therapy, Chapter 9 Obesity (Medoroga) in [[Ayurveda]]; eBook, published by CRC press, Taylor & Francis Group.  </ref>. Vitiation of ''kapha dosha'' and excessive accumulation of fat-specific energy and waste products of adipose tissues (''kleda'') lead to dysfunction of adipose tissues. Adipose channels have two origins - kidney, adrenal and fat around them and other are visceral and omental fat (''vapavahana'')<ref>Shastri, P.K (1983), (translater), Caraka samhita, Part I, 2nd ed., Chaukhambha Sanskrit Sansthan, Varanasi, India, p. 595. </ref>. These channels draw nutrition, including lipid from the antecedent flesh and transient lipid and then convert them into a stored form of lipid. As per biomedical science, obesity is associated with increased adipose stores in the subcutaneous tissues, skeletal muscles and internal organs such as kidney, heart, liver and omentum. Adipose tissues (''medodhatu'') form a crucial link to the concept of tissue metabolism. Low levels of fat-specific energy (''medodhatvagni''), despite a normal food intake, can lead to a steady accumulation of fat and the outcome is obesity<ref>Bleich S, Cutler D, Murray C, Adams A (2008). "Why is the developed world obese?". Annu Rev Public Health29: 273–95. doi:10.1146/annurev.publhealth.29.020907.090954. PMID 18173389. </ref>  <ref>Drewnowski A, Specter SE (January 2004). "Poverty and obesity: the role of energy density and energy costs". Am. J. Clin. Nutr.79 (1): 6–16.  </ref>. The conventional system of medicine has given due consideration to certain factors such as insufficient sleep, genetic predisposition, later age pregnancy, certain medications and other epigenetic factors in the etiopathogenesis of obesity and its related disorders<ref>Keith SW, Redden DT, Katzmarzyk PT et al. (2006). "Putative contributors to the secular increase in obesity: Exploring the roads less traveled". Int J Obes (Lond)30 (11): 1585–94. doi:10.1038/sj.ijo.0803326. PMID 16801930. </ref>.(Verse 3-4)